Organization
RUDDELL ROAD DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED DOUGLAS PERSINGER DDS (DENTIST/OWNER)
(360) 459-1600
Entity
Organization
Contact information
Practice address
1607 RUDDELL RD SE, LACEY, WA 98503-2757
(360) 459-1600
Mailing address
1607 RUDDELL RD SE, LACEY, WA 98503-2757
(360) 459-1600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60170217
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114158730
INDIVIDUAL NPI FOR DR. JARED D. PERSINGER, DDS
WA
Enumeration date
08/12/2010
Last updated
01/31/2012
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