Provider Demographics
NPI:1699839589
Name:HSU, JEFFREY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:HSU
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 1:430 TERRA EDEN ST
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-9604
Mailing Address - Country:US
Mailing Address - Phone:360-374-6868
Mailing Address - Fax:360-374-3870
Practice Address - Street 1:430 TERRA EDEN ST
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9604
Practice Address - Country:US
Practice Address - Phone:360-374-6868
Practice Address - Fax:360-374-3870
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice