MEDICARE: EID, JABER, JASSAR PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1043177462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EID, JABER, JASSAR PLLC

Provider Business Mailing Address
First Line	:	1717 OLYMPIA WAY STE 108
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3929
Country	:	US
Telephone Number	:	360-636-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3519 56TH ST STE 140
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8593
Country	:	US
Telephone Number	:	360-636-1900
Fax Number	:

Authorized Official
Title or Position	:	HR MANAGER
Name	:	REBECCA OCONNOR
Credential	:	MSHRM
Telephone Number	:	360-636-1900

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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