Provider Demographics
NPI:1528184371
Name:BARUFFI, JEROME ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ROBERT
Last Name:BARUFFI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 STRANDER BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2935
Mailing Address - Country:US
Mailing Address - Phone:206-575-1551
Mailing Address - Fax:
Practice Address - Street 1:411 STRANDER BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2935
Practice Address - Country:US
Practice Address - Phone:206-575-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000033551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice