Provider Demographics
NPI:1073524138
Name:J ERIC JANASZAK DMD
Entity Type:Organization
Organization Name:J ERIC JANASZAK DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:JANASZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-769-0667
Mailing Address - Street 1:PO BOX 4063
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLBY
Mailing Address - State:WA
Mailing Address - Zip Code:98384
Mailing Address - Country:US
Mailing Address - Phone:206-715-9391
Mailing Address - Fax:
Practice Address - Street 1:10407 SE OLYMPIAD DR.
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:206-715-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty