Provider Demographics
NPI:1114126539
Name:JARRETT, ALEX BLAKE (DDS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:BLAKE
Last Name:JARRETT
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 1:8105 166TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3999
Mailing Address - Country:US
Mailing Address - Phone:425-885-5119
Mailing Address - Fax:425-882-0204
Practice Address - Street 1:8105 166TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3999
Practice Address - Country:US
Practice Address - Phone:425-885-5119
Practice Address - Fax:425-882-0204
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000109981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice