Provider Demographics
NPI:1073733200
Name:JAYNE, DONALD MELVIN (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MELVIN
Last Name:JAYNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3003
Mailing Address - Country:US
Mailing Address - Phone:206-623-4400
Mailing Address - Fax:206-623-4411
Practice Address - Street 1:1119 4TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3003
Practice Address - Country:US
Practice Address - Phone:206-623-4400
Practice Address - Fax:206-623-4411
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist