Individual
JACLYN LIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
6060 PORTAL WAY, FERNDALE, WA 98248-7833
(360) 676-6177
(360) 671-3574
Mailing address
1616 CORNWALL AVE STE 215, BELLINGHAM, WA 98225-4648
(360) 676-6177
(360) 671-3574
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DEHY.DH.61078723
WA
Other
Enumeration date
12/19/2021
Last updated
01/19/2022
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