Jeanne L Bertino, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DE00006272 Issued in WA

Practice address

2611 NE 125TH St
Suite 236
Seattle, WA 98125-4373

Phone

(206) 365-5880

Fax

(206) 365-6412

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Anusha R Etikala BDS Ms PLLC

  • Dental Clinic/Center
  • Seattle, WA
  • NPI 1962361535
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043367436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 NE 125TH ST",
            "address_2": "SUITE 236",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981254373",
            "telephone_number": "206-365-5880",
            "fax_number": "206-365-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 NE 125TH ST",
            "address_2": "SUITE 236",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981254373",
            "telephone_number": "206-365-5880",
            "fax_number": "206-365-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTINO",
        "first_name": "JEANNE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE00006272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander L Bertelsen, PAC
• Cleopatra S Bertelsen, LMP
• Eching Voon Bertelsen, PA C
• Kimberly Anne Bertens, MD
• Madeleine Elizabeth Bertin, MSW, MHP, CMHS
• Verie May Bertoglio, LPTA
• Madison Bertolin
• Sierra Bertolone-Smith
• Aaron Moens Bertoni, M.D.
• Sheila E Bertoso, MD

• All providers in Seattle, WA
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.