NPIMap

Organization Active NPI

Ruddell Road Dental Center

  • General Practice Dentistry
  • Lacey, WA
National Provider Identifier
1295040327
Registry record updated Jan 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE60170217 Issued in WA
Legal business name
RUDDELL ROAD DENTAL CENTER
Practice address
1607 Ruddell Rd SE
Lacey, WA 98503-2757
Phone
(360) 459-1600
NPI assigned
Aug 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2012

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

Authorized official

Name
Dr. Jared Douglas Persinger, DDSNPI 1114158730
Title
Dentist/Owner
Phone
(360) 459-1600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DE60170217 WA Primary

Addresses

Primary practice location

1607 Ruddell Rd SE
Lacey, WA 98503-2757

Mailing address

1607 Ruddell Rd SE
Lacey, WA 98503-2757
Phone (360) 459-1600

Other identifiers 1

IdentifierTypeStateIssuer
1114158730OtherWAINDIVIDUAL NPI FOR DR. JARED D. PERSINGER, DDS

National Provider Directory

National Provider Directory

Locations

1607 Ruddell Rd SE
Lacey, WA 98503
Phone (360) 459-1600

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327968000000",
    "number": "1295040327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 RUDDELL RD SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985032757",
            "telephone_number": "360-459-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 RUDDELL RD SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985032757",
            "telephone_number": "360-459-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUDDELL ROAD DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-12",
        "last_updated": "2012-01-31",
        "status": "A",
        "authorized_official_last_name": "PERSINGER",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "360-459-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60170217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI FOR DR. JARED D. PERSINGER, DDS",
            "identifier": "1114158730",
            "state": "WA"
        }
    ],
    "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 Jan 31, 2012; 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.