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General NPI Number Information
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NPI Number | 1083902928
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Entity Type | Organization
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Legal Business Name | JANSEN RICHINS DDS PC
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Dates
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Enumeration Date | 07/13/2011
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 509 OLIVE WAY SUITE 1524
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City | SEATTLE
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State | WA
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Zip | 98101-1720
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Country | US
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Telephone | 206-223-1501
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Fax |
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Provider Business Mailing Address
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Address Line | 509 OLIVE WAY SUITE 1524
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City | SEATTLE
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State | WA
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Zip | 98101-1720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANSEN RICHINS
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Credential |
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Telephone | 405-535-1676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE 60230330
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License Number State | WA
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