Healthcare Provider Details

I. General information

NPI: 1740294511
Provider Name (Legal Business Name): JENNIFER BIELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 HOSPITAL DR STE 103
SEDRO WOOLLEY WA
98284-4329
US

IV. Provider business mailing address

2261 HOSPITAL DR STE 103
SEDRO WOOLLEY WA
98284-4329
US

V. Phone/Fax

Practice location:
  • Phone: 360-854-0606
  • Fax:
Mailing address:
  • Phone: 360-854-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE 8124
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: