Provider Demographics
NPI:1760712012
Name:EMARD, JESSICA JANIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JANIS
Last Name:EMARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2434
Mailing Address - Country:US
Mailing Address - Phone:206-718-5865
Mailing Address - Fax:
Practice Address - Street 1:280 HARDIE AVE SW STE 3
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5900
Practice Address - Country:US
Practice Address - Phone:425-430-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 600989991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice