NPIMap

Organization Active NPI

Peter W Jacobsen DDS PLLC

  • General Practice Dentistry
  • Maple Valley, WA
National Provider Identifier
1053480988
Registry record updated Aug 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00005267 Issued in WA
Legal business name
PETER W JACOBSEN DDS PLLC
Practice address
27016 Maple Valley BLK Diamond Rd SE
Maple Valley, WA 98038
Phone
(425) 413-8525
Fax
(425) 413-8599
NPI assigned
Nov 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2008

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

Authorized official

Name
Julie S Cielo
Title
Manager
Phone
(425) 413-8525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DE00005267 WA Primary

Addresses

Primary practice location

27016 Maple Valley BLK Diamond Rd SE
Maple Valley, WA 98038

Mailing address

27016 Maple Valley BLK Diamond Rd SE
Maple Valley, WA 98038
Phone (425) 413-8525

Other names 1

  • Maple Valley Family Dental Care Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217548800000",
    "number": "1053480988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27016 MAPLE VALLEY BLK DIAMOND RD SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "98038",
            "telephone_number": "425-413-8525",
            "fax_number": "425-413-8599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27016 MAPLE VALLEY BLK DIAMOND RD SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "98038",
            "telephone_number": "425-413-8525",
            "fax_number": "425-413-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER W JACOBSEN DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-08-01",
        "status": "A",
        "authorized_official_last_name": "CIELO",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "425-413-8525"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00005267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Valley Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; 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.