MEDICARE: DR. JEFFREY D. HULEATT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00006048	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE00006048	OTHER	WA	STATE LICENSE ID

General Provider Information

NPI Number	:	1972514453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY D. HULEATT D.D.S.

Provider Business Mailing Address
First Line	:	20210 77TH AVE NE
Second Line	:	P O BOX 98
City	:	ARLINGTON
State	:	WA
Zip	:	98223-0098
Country	:	US
Telephone Number	:	360-435-2151
Fax Number	:	360-435-7845

Provider Business Practice Location Address
First Line	:	20210 77TH AVE NE
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-4602
Country	:	US
Telephone Number	:	360-435-2151
Fax Number	:	360-435-7845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JEFFREY D. HULEATT D.D.S.” Practice Location

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