Provider Demographics
NPI:1730638933
Name:WREN, JASLYN F (DHAT)
Entity Type:Individual
Prefix:
First Name:JASLYN
Middle Name:F
Last Name:WREN
Suffix:
Gender:F
Credentials:DHAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35151
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5151
Mailing Address - Country:US
Mailing Address - Phone:907-317-6070
Mailing Address - Fax:907-729-5178
Practice Address - Street 1:4341 TUDOR CENTRE DR
Practice Address - Street 2:FIREWEED DENTAL BUILDING
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-317-6070
Practice Address - Fax:907-729-5178
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16-137-DHAT125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist