Active NPI
Jessica Leal, DDS
- Dentist
- Everett, WA
National Provider Identifier
1265119622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61471975
- Practice address
- 1031 SE Everett Mall Way Ste 101
Everett, WA 98208-2833 - Phone
- (425) 426-2027
- NPI assigned
- Jun 28, 2023
- Last updated
- Sep 22, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61471975 | WA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
1031 SE Everett Mall Way Ste 101
Everett, WA 98208-2833
Mailing address
1031 SE Everett Mall Way Ste 101
Everett, WA 98208-2833
Phone (425) 426-2077
Other practice location 1
345 E 24th St
New York, NY 10010-4020
Phone (212) 998-9800
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240130003197 | WA | Order and Referring Only - Dentist | 6002269669 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61471975 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington Dental Corporation, PC | Dentist | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695340800000",
"number": "1265119622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1031 SE EVERETT MALL WAY STE 101",
"city": "EVERETT",
"state": "WA",
"postal_code": "982082833",
"telephone_number": "425-426-2077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1031 SE EVERETT MALL WAY STE 101",
"city": "EVERETT",
"state": "WA",
"postal_code": "982082833",
"telephone_number": "425-426-2027"
}
],
"practiceLocations": [
{
"address_1": "345 E 24th St",
"address_purpose": "LOCATION",
"city": "New York",
"state": "NY",
"postal_code": "100104020",
"country_code": "US",
"telephone_number": "212-998-9800",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEAL",
"first_name": "JESSICA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-28",
"last_updated": "2023-09-22",
"certification_date": "2023-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "61471975",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; 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.