Healthcare Provider Details

I. General information

NPI: 1265453393
Provider Name (Legal Business Name): JACQUELINE DE LEON-ESTES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE DE LEON DMD

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 HARBOUR REACH DR SUITE 210
MUKILTEO WA
98275-5314
US

IV. Provider business mailing address

12121 HARBOUR REACH DR SUITE 210
MUKILTEO WA
98275-5314
US

V. Phone/Fax

Practice location:
  • Phone: 425-348-5060
  • Fax: 425-493-8712
Mailing address:
  • Phone: 425-348-5060
  • Fax: 425-493-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00009255
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: