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General NPI Number Information
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NPI Number | 1720204266
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Entity Type | Organization
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Legal Business Name | JED V. SANTIAGO, DDS, PLLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 18505 ALDERWOOD MALL PKWY SUITE D
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City | LYNNWOOD
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State | WA
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Zip | 98037-8012
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Country | US
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Telephone | 425-712-0800
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Fax | 425-670-1125
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Provider Business Mailing Address
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Address Line | 18505 ALDERWOOD MALL PKWY SUITE D
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City | LYNNWOOD
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State | WA
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Zip | 98037-8012
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Country | US
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Telephone | 425-712-0800
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Fax | 425-670-1125
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Authorized Official
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Title or Position | OWNER
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Name | DR. JED VAL SANTIAGO
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Credential | D.D.S.
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Telephone | 425-712-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00009386
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License Number State | WA
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