Jake Ericksen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE61166100 Issued in WA

Practice address

5611 119TH Ave SE Ste 2
Bellevue, WA 98006-3799

Phone

(425) 746-6554

NPI assigned

May 20, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Newport Hills Dental

  • General Practice Dentistry
  • Bellevue, WA
  • NPI 1437009024
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1023683398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 EASTLAKE AVE E APT 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981023787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5611 119TH AVE SE STE 2",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980063799",
            "telephone_number": "425-746-6554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSEN",
        "first_name": "JAKE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61166100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rylie Louise Regan Enslin
• Tina Marie Ensminger, MA
• Envision Behavioral Health, LLC
• Selena B Eon, ND
• Equilibrium PCS, PLLC
• Brooke Erickson
• Carrie S Erickson, LMFT
• Kathryn W Erickson, MD
• Terri Ericson, LMP
• Erik H Suh MD PSC

• Dentist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.