Organization
JAWNT ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE FOWLER (OFFICE COORDINATOR)
(360) 391-7872
Entity
Organization
Contact information
Practice address
15823 WESTMINSTER WAY N, SHORELINE, WA 98133-5928
(206) 848-5788
(206) 734-3747
Mailing address
15823 WESTMINSTER WAY N, SHORELINE, WA 98133-5928
(206) 848-5788
(206) 734-3747
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417269200
NPI
WA
Enumeration date
03/14/2022
Last updated
03/14/2022
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