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General NPI Number Information
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NPI Number | 1578904108
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Entity Type | Individual
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Provider Name | KATHRYN LYNN JAGOW D.D.S
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Gender | Female
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 22905 56TH AVE W 101
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-3925
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Country | US
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Telephone | 253-266-8656
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Fax |
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Provider Business Mailing Address
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Address Line | 22905 56TH AVE W 101
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-3925
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Country | US
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Telephone | 425-776-2323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DENT.DE.60363985
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License Number State | WA
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