Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DE 60289981 | WA |
NPI | 1194957795 |
---|---|
Provider Name | Deepali Jere |
First Address | Shoreline, WA 98133-3521 |
Second Address | Shoreline, WA 98133-3521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 18/09/2017 |