Individual
JENNIFER TA LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
14201 NE 20TH AVE STE A101, VANCOUVER, WA 98686-6411
(360) 882-0222
Mailing address
PO BOX 34703, SEATTLE, WA 98124-1703
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DE61309953
WA
1223G0001X
General Practice Dentistry
D11518
OR
1223G0001X
General Practice Dentistry
Primary
DE61309953
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2309037
—
WA
Enumeration date
08/29/2021
Last updated
10/24/2025
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