Provider Demographics
NPI:1578904108
Name:JAGOW, KATHRYN LYNN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LYNN
Last Name:JAGOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:LYNN
Other - Last Name:CUMBIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22905 56TH AVE W
Mailing Address - Street 2:101
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3925
Mailing Address - Country:US
Mailing Address - Phone:425-776-2323
Mailing Address - Fax:
Practice Address - Street 1:22905 56TH AVE W
Practice Address - Street 2:101
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-3925
Practice Address - Country:US
Practice Address - Phone:253-266-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.60363985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist