Provider Demographics
NPI:1215380373
Name:JENNIFER OHSIE, DDS, PLLC
Entity Type:Organization
Organization Name:JENNIFER OHSIE, DDS, PLLC
Other - Org Name:BALLARD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OHSIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-427-7275
Mailing Address - Street 1:6707 SYCAMORE AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4849
Mailing Address - Country:US
Mailing Address - Phone:206-427-7275
Mailing Address - Fax:
Practice Address - Street 1:1551 NW 54TH ST STE 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3845
Practice Address - Country:US
Practice Address - Phone:206-789-5234
Practice Address - Fax:206-783-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10363261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental