Provider Demographics
NPI:1962457036
Name:PEHLING, JASON P (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:PEHLING
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:2111 N NORTHGATE WAY
Mailing Address - Street 2:STE. 221
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-363-8240
Mailing Address - Fax:206-363-8301
Practice Address - Street 1:2111 N NORTHGATE WAY
Practice Address - Street 2:STE. 221
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-363-8240
Practice Address - Fax:206-363-8301
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA155609OtherLABOR AND INDUSTRIES
WA62308OtherCIGNA
WASB930OtherPREMERA MEDICAL
WA91131OtherCARPENTER'S HEALTH PLAN
WA93200OtherBLUE CROSS BLUE SHIELD
WA77777OtherDELTA DENTAL
932000OtherREGENCE
WA47570OtherPREMERA DENTAL
WA60054OtherAETNA DENTAL
WA60054OtherAETNA MEDICAL
WA60054OtherAETNA DENTAL