| Jack Ehlen, Dds & Julie Fuller, Dds | |
|
11208 94th Ave E Suite B Puyallup WA 98373-3663 | |
| (253) 848-4597 | |
| Not Available |
| Full Name | Jack Ehlen, Dds & Julie Fuller, Dds |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11208 94th Ave E, Puyallup, Washington |
| Authorized Official Name and Position | Julie Fuller (DENTIST/OWNER) |
| Authorized Official Contact | 2538484597 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack Ehlen, Dds & Julie Fuller, Dds 11208 94th Ave E Suite B Puyallup WA 98373-3663 Ph: (253) 848-4597 | Jack Ehlen, Dds & Julie Fuller, Dds 11208 94th Ave E Suite B Puyallup WA 98373-3663 Ph: (253) 848-4597 |
| NPI Number | 1316234735 |
|---|---|
| Provider Enumeration Date | 07/06/2011 |
| Last Update Date | 07/06/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316234735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE60100274 (Washington) | Primary |
| 1223G0001X | Dentist - General Practice | DE00006157 (Washington) | Secondary |
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