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General NPI Number Information
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NPI Number | 1679413728
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Entity Type | Organization
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Legal Business Name | EID, JABER, JASSAR PLLC
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 4312 S SETTLER DR STE 100
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City | RIDGEFIELD
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State | WA
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Zip | 98642-4532
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Country | US
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Telephone | 360-636-1900
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Fax | 360-636-7317
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Provider Business Mailing Address
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Address Line | 1717 OLYMPIA WAY STE 108
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City | LONGVIEW
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State | WA
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Zip | 98632-3929
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Country | US
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Telephone | 360-636-1900
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Fax | 360-636-7317
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Authorized Official
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Title or Position | CREDENTIALING
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Name | REBECCA OCONNOR
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Credential | MSHRM
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Telephone | 360-636-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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