Provider Demographics
NPI:1225619984
Name:DESPAIN BOYACK PLLC
Entity Type:Organization
Organization Name:DESPAIN BOYACK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:DESPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-565-5066
Mailing Address - Street 1:150 W SEQUIM BAY RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8406
Mailing Address - Country:US
Mailing Address - Phone:360-565-5066
Mailing Address - Fax:360-504-2237
Practice Address - Street 1:321 N SEQUIM AVE STE D
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3686
Practice Address - Country:US
Practice Address - Phone:360-683-5700
Practice Address - Fax:360-683-7132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOYACK & DESPAIN PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty