Healthcare Provider Details

I. General information

NPI: 1275607905
Provider Name (Legal Business Name): JENNIFER C OHSIE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 NW 54TH ST #104
SEATTLE WA
98107-3845
US

IV. Provider business mailing address

1551 NW 54TH ST #104
SEATTLE WA
98107-3845
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-5234
  • Fax: 206-783-1694
Mailing address:
  • Phone: 206-789-5234
  • Fax: 206-783-1694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00010363
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: