Active NPI
Jason Sholly
- Dentist
- Lacey, WA
National Provider Identifier
1144715293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE6085544
- Practice address
- 909 Sleater Kinney Rd SE Ste 3
Lacey, WA 98503-1103 - Phone
- (360) 491-1414
- Fax
- (360) 628-8015
- NPI assigned
- Jun 29, 2018
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DE6085544 | WA | Primary |
Addresses
Primary practice location
909 Sleater Kinney Rd SE Ste 3
Lacey, WA 98503-1103
Mailing address
5401 6TH Ave Ste 201
Tacoma, WA 98406-2618
Phone (253) 759-5437
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE6085544 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smiles 4 Kids Lacey. PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Olimpia, WA
- NPI 1982026407
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530230400000",
"number": "1144715293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5401 6TH AVE STE 201",
"city": "TACOMA",
"state": "WA",
"postal_code": "984062618",
"telephone_number": "253-759-5437",
"fax_number": "253-426-1836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 SLEATER KINNEY RD SE STE 3",
"city": "LACEY",
"state": "WA",
"postal_code": "985031103",
"telephone_number": "360-491-1414",
"fax_number": "360-628-8015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOLLY",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-29",
"last_updated": "2018-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE6085544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.