Provider Demographics
NPI:1184000424
Name:JENNIFER S EMERSON D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:JENNIFER S EMERSON D.D.S., P.L.L.C.
Other - Org Name:NORTH SEATTLE RESTORATIVE AND PREVENTATIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-486-2715
Mailing Address - Street 1:5701 NE BOTHELL WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9400
Mailing Address - Country:US
Mailing Address - Phone:425-486-2715
Mailing Address - Fax:425-486-5782
Practice Address - Street 1:5701 NE BOTHELL WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9400
Practice Address - Country:US
Practice Address - Phone:425-486-2715
Practice Address - Fax:425-486-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty