Provider Demographics
NPI:1073697116
Name:WAY, JON L (DDS, MS,PLLC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:L
Last Name:WAY
Suffix:
Gender:M
Credentials:DDS, MS,PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6527 SUNNYSIDE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5422
Mailing Address - Country:US
Mailing Address - Phone:206-523-4402
Mailing Address - Fax:
Practice Address - Street 1:4500 SAND POINT WAY NE STE 208
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3925
Practice Address - Country:US
Practice Address - Phone:206-525-4777
Practice Address - Fax:206-525-8677
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000062391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry