Provider Demographics
NPI:1821398751
Name:DABELL, JACOB E (DDS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:E
Last Name:DABELL
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 1:4200 MARY GATES MEMORIAL DR NE
Mailing Address - Street 2:#Y275
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5647
Mailing Address - Country:US
Mailing Address - Phone:919-259-4380
Mailing Address - Fax:
Practice Address - Street 1:720 N EVERGREEN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0856
Practice Address - Country:US
Practice Address - Phone:509-466-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 600130391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics