Provider Demographics
NPI:1326044058
Name:MAO, ER-JIA (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:ER-JIA
Middle Name:
Last Name:MAO
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 N NORTHGATE WAY
Mailing Address - Street 2:STE 215
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-367-6767
Mailing Address - Fax:206-367-4788
Practice Address - Street 1:2111 N NORTHGATE WAY
Practice Address - Street 2:STE 215
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9018
Practice Address - Country:US
Practice Address - Phone:206-367-6767
Practice Address - Fax:206-367-4788
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE84641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics