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4915 25th Ave Ne Suite 107 Seattle WA 98105-5667 | |
| (206) 381-0732 | |
| (206) 381-0513 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4915 25th Ave Ne, Seattle, Washington |
| Authorized Official Name and Position | Elizabeth Headley Jacobsen (GENERAL DENTIST) |
| Authorized Official Contact | 2063810732 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4915 25th Ave Ne Suite 107 Seattle WA 98105-5667 Ph: (206) 381-0732 | 4915 25th Ave Ne Suite 107 Seattle WA 98105-5667 Ph: (206) 381-0732 |
| NPI Number | 1487914487 |
|---|---|
| Provider Enumeration Date | 05/23/2012 |
| Last Update Date | 05/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487914487 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DE40021232 (Washington) | Primary |
| 122300000X | Dentist | DE60035233 (Washington) | Secondary |
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