=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972514453
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY D. HULEATT D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20210 77TH AVE NE
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-435-2151
-----------------------------------------------------
Fax | 360-435-7845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20210 77TH AVE NE P O BOX 98
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-0098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-435-2151
-----------------------------------------------------
Fax | 360-435-7845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE00006048
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------