Healthcare Provider Details

I. General information

NPI: 1043367436
Provider Name (Legal Business Name): JEANNE L BERTINO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 NE 125TH ST SUITE 236
SEATTLE WA
98125-4373
US

IV. Provider business mailing address

2611 NE 125TH ST SUITE 236
SEATTLE WA
98125-4373
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-5880
  • Fax: 206-365-6412
Mailing address:
  • Phone: 206-365-5880
  • Fax: 206-365-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00006272
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: