Individual
JASON SHOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
909 SLEATER KINNEY RD SE STE 3, LACEY, WA 98503-1103
(360) 491-1414
(360) 628-8015
Mailing address
5401 6TH AVE STE 201, TACOMA, WA 98406-2618
(253) 759-5437
(253) 426-1836
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE6085544
WA
Other
Enumeration date
06/29/2018
Last updated
06/29/2018
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