Provider Demographics
NPI:1346323516
Name:JANSSEN, INGRID R (DDS)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:R
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 ENSIGN RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5039
Mailing Address - Country:US
Mailing Address - Phone:360-438-2735
Mailing Address - Fax:360-528-2278
Practice Address - Street 1:3701 ENSIGN RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5039
Practice Address - Country:US
Practice Address - Phone:360-438-2735
Practice Address - Fax:360-528-2278
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000078861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00007886OtherSTATE LICENSE NUMBER