Healthcare Provider Details

I. General information

NPI: 1972514453
Provider Name (Legal Business Name): JEFFREY D. HULEATT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20210 77TH AVE NE
ARLINGTON WA
98223-4602
US

IV. Provider business mailing address

20210 77TH AVE NE P O BOX 98
ARLINGTON WA
98223-0098
US

V. Phone/Fax

Practice location:
  • Phone: 360-435-2151
  • Fax: 360-435-7845
Mailing address:
  • Phone: 360-435-2151
  • Fax: 360-435-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00006048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: