Healthcare Provider Details

I. General information

NPI: 1376598847
Provider Name (Legal Business Name): JASON PEHLING DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 N NORTHGATE WAY STE 221
SEATTLE WA
98133-9018
US

IV. Provider business mailing address

2111 N NORTHGATE WAY STE 221
SEATTLE WA
98133
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-8240
  • Fax: 206-363-8301
Mailing address:
  • Phone: 206-363-8240
  • Fax: 206-363-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00008992
License Number StateWA

VIII. Authorized Official

Name: DR. JASON P PEHLING
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 206-363-8240