Active NPI
Jason R Bourne, DDS, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Marysville, WA
National Provider Identifier
1104922194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DE00009603
- Practice address
- 815 State Ave
Suite 3
Marysville, WA 98270-4254 - Phone
- (360) 659-0211
- Fax
- (360) 658-0716
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DE00009603 | WA | Primary |
Addresses
Primary practice location
815 State Ave
Suite 3
Marysville, WA 98270-4254
Mailing address
815 State Ave
Suite 3
Marysville, WA 98270-4254
Phone (360) 659-0211
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00009603 | WA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104922194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 STATE AVE",
"address_2": "SUITE 3",
"city": "MARYSVILLE",
"state": "WA",
"postal_code": "982704254",
"telephone_number": "360-659-0211",
"fax_number": "360-658-0716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 STATE AVE",
"address_2": "SUITE 3",
"city": "MARYSVILLE",
"state": "WA",
"postal_code": "982704254",
"telephone_number": "360-659-0211",
"fax_number": "360-658-0716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURNE",
"first_name": "JASON",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WA",
"license": "DE00009603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marysville, WA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.