Provider Demographics
NPI:1265453393
Name:DE LEON-ESTES, JACQUELINE (DMD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DE LEON-ESTES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:12121 HARBOUR REACH DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5314
Mailing Address - Country:US
Mailing Address - Phone:425-348-5060
Mailing Address - Fax:425-493-8712
Practice Address - Street 1:12121 HARBOUR REACH DR
Practice Address - Street 2:SUITE 210
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5314
Practice Address - Country:US
Practice Address - Phone:425-348-5060
Practice Address - Fax:425-493-8712
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000092551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1542904OtherUNITED CONCORDIA