Healthcare Provider Details

I. General information

NPI: 1063485894
Provider Name (Legal Business Name): GARY WAYNE JARRETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 166TH AVE NE #201
REDMOND WA
98052-3999
US

IV. Provider business mailing address

8105 166TH AVE NE #201
REDMOND WA
98052-3999
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-5119
  • Fax: 425-882-0204
Mailing address:
  • Phone: 425-885-5119
  • Fax: 425-882-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4433
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: