Healthcare Provider Details

I. General information

NPI: 1922917178
Provider Name (Legal Business Name): FEDERAL WAY ORAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33801 1ST WAY S STE 311
FEDERAL WAY WA
98003-4548
US

IV. Provider business mailing address

33801 1ST WAY S STE 311
FEDERAL WAY WA
98003-4548
US

V. Phone/Fax

Practice location:
  • Phone: 817-646-0089
  • Fax:
Mailing address:
  • Phone: 817-646-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JILL DUNNAM
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 817-226-6790