Provider Demographics
NPI:1750395893
Name:PICHLER, JENNIFER (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:PICHLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9776 HOLMAN RD NW
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2000
Mailing Address - Country:US
Mailing Address - Phone:206-782-0600
Mailing Address - Fax:206-782-4197
Practice Address - Street 1:9776 HOLMAN RD NW
Practice Address - Street 2:SUITE 107
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-2000
Practice Address - Country:US
Practice Address - Phone:206-782-0600
Practice Address - Fax:206-782-4197
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA99141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5050372Medicaid