Healthcare Provider Details

I. General information

NPI: 1730638933
Provider Name (Legal Business Name): JASLYN F WREN DHAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 TUDOR CENTRE DR FIREWEED DENTAL BUILDING
ANCHORAGE AK
99508-5904
US

IV. Provider business mailing address

PO BOX 35151
SEATTLE WA
98124-5151
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-6070
  • Fax: 907-729-5178
Mailing address:
  • Phone: 907-317-6070
  • Fax: 907-729-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number16-137-DHAT
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: