Provider Demographics
NPI:1376598847
Name:JASON PEHLING DDS MS PC
Entity Type:Organization
Organization Name:JASON PEHLING DDS MS PC
Other - Org Name:TMJ OROFACIAL DISORDERS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:PEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:206-363-8240
Mailing Address - Street 1:2111 N NORTHGATE WAY
Mailing Address - Street 2:STE 221
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-363-8240
Mailing Address - Fax:206-363-8301
Practice Address - Street 1:2111 N NORTHGATE WAY
Practice Address - Street 2:STE 221
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9018
Practice Address - Country:US
Practice Address - Phone:206-363-8240
Practice Address - Fax:206-363-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA93200OtherREGENCE
WA47570OtherPREMERA DENTAL
WASB930OtherPREMERA MEDICAL
WAGAB26855Medicare PIN
WASB930OtherPREMERA MEDICAL