Provider Demographics
NPI:1295171403
Name:JARMUSCH, ALESHA (D160083865)
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:
Last Name:JARMUSCH
Suffix:
Gender:F
Credentials:D160083865
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 16TH ST NE
Mailing Address - Street 2:#G6
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7725
Mailing Address - Country:US
Mailing Address - Phone:253-583-6832
Mailing Address - Fax:
Practice Address - Street 1:12506 16TH ST NE
Practice Address - Street 2:#G6
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7725
Practice Address - Country:US
Practice Address - Phone:253-583-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD160083865126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant