MEDICARE: JURGA MARTINI DMD PS

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	1223G0001X	General Practice Dentistry	8704	WA

General Provider Information

NPI Number	:	1235684788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JURGA MARTINI DMD PS

Provider Business Mailing Address
First Line	:	1220 HOWELL ST
Second Line	:	SUITE 110
City	:	SEATTLE
State	:	WA
Zip	:	98101-1469
Country	:	US
Telephone Number	:	206-464-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 HOWELL ST
Second Line	:	SUITE 110
City	:	SEATTLE
State	:	WA
Zip	:	98101-1469
Country	:	US
Telephone Number	:	206-464-9002
Fax Number	:	206-464-9003

Authorized Official
Title or Position	:	OWNER
Name	:	JURGA MARTINI
Credential	:
Telephone Number	:	206-464-9002

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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