Provider Demographics
NPI:1174000467
Name:RAASTAD, JESSICA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:RAASTAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S 357TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8603
Mailing Address - Country:US
Mailing Address - Phone:425-306-1835
Mailing Address - Fax:
Practice Address - Street 1:16202 64TH ST E STE 101
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3028
Practice Address - Country:US
Practice Address - Phone:253-891-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60877921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist