Provider Demographics
NPI:1952668113
Name:JON L. WAY DDS, MS, PLLC
Entity Type:Organization
Organization Name:JON L. WAY DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PLLC
Authorized Official - Phone:360-424-3811
Mailing Address - Street 1:2210 KULSHAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2779
Mailing Address - Country:US
Mailing Address - Phone:360-424-3811
Mailing Address - Fax:360-424-8703
Practice Address - Street 1:2210 KULSHAN VIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2779
Practice Address - Country:US
Practice Address - Phone:360-424-3811
Practice Address - Fax:360-424-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6239122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty