Healthcare Provider Details

I. General information

NPI: 1710096375
Provider Name (Legal Business Name): JON A. DALLMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 98TH AVE NE SUITE 2
BOTHELL WA
98011-3391
US

IV. Provider business mailing address

18321 98TH AVE NE SUITE 2
BOTHELL WA
98011-3391
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-6300
  • Fax: 425-487-6498
Mailing address:
  • Phone: 425-486-6300
  • Fax: 425-487-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7837
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: