Organization
JD ONLINE LLC
Active
Organization
JD ONLINE LLC
Active
Other names
Washington Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED DEAN EVANS DMD (DENTIST)
(509) 389-9333
Entity
Organization
Contact information
Practice address
23403 E MISSION AVE, SUITE 217, LIBERTY LAKE, WA 99019
(509) 645-2640
(509) 891-4741
Mailing address
1327 N STANFORD LN, LIBERTY LAKE, WA 99019
(509) 389-9333
(509) 891-4741
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
302F00000X
Exclusive Provider Organization
—
—
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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