Provider Demographics
NPI:1740027127
Name:NEALON, JAKE MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:MICHAEL
Last Name:NEALON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7231 230TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-7926
Mailing Address - Country:US
Mailing Address - Phone:425-761-6802
Mailing Address - Fax:
Practice Address - Street 1:999 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-4019
Practice Address - Country:US
Practice Address - Phone:206-343-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61575111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist