Active NPI
Jasiah Took Ruby-Schultz, CDA
- Dental Assistant
- Lacey, WA
National Provider Identifier
1245084979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 264321
- Practice address
- 8050 Freedom LN NE Ste C
Lacey, WA 98516-4761 - Phone
- (360) 464-4597
- NPI assigned
- Apr 17, 2024
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 264321 | WA | Primary |
Addresses
Primary practice location
8050 Freedom LN NE Ste C
Lacey, WA 98516-4761
Mailing address
1801 Evergreen Park CT SW Apt 23
Olympia, WA 98502-5859
Phone (206) 434-0877
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 |
|---|---|---|---|
| 264321 | WA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713312000000",
"number": "1245084979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 EVERGREEN PARK CT SW APT 23",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985025859",
"telephone_number": "206-434-0877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8050 FREEDOM LN NE STE C",
"city": "LACEY",
"state": "WA",
"postal_code": "985164761",
"telephone_number": "360-464-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUBY-SCHULTZ",
"first_name": "JASIAH",
"middle_name": "TOOK",
"credential": "CDA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-17",
"last_updated": "2024-04-17",
"certification_date": "2024-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "WA",
"license": "264321",
"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 Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.