Individual
JAY D DEIGLMEIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10920 SE 208TH ST, KENT, WA 98031-4009
(253) 854-1222
Mailing address
10920 SE 208TH ST, KENT, WA 98031-4009
(253) 854-1222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00007064
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103746
L & I
WA
05
—
5023221
—
WA
05
—
5025788
—
WA
01
—
57064
WDS
WA
01
—
DE7654
REGENCE
WA
Enumeration date
11/14/2006
Last updated
07/08/2007
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