NPIMap

Organization Active NPI

Jay D. Deiglmeier DDS. PS

  • General Practice Dentistry
  • Kent, WA
National Provider Identifier
1316010531
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00007064 Issued in WA
Legal business name
JAY D. DEIGLMEIER DDS. PS
Doing business as
Panther Lake Dental
Practice address
10920 SE 208TH St
Kent, WA 98031-4009
Phone
(253) 854-1222
Fax
(253) 859-1269
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jay D Deiglmeier, DDSNPI 1548332653
Title
President
Phone
(253) 854-1222

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 DE00007064 WA Primary

Addresses

Primary practice location

10920 SE 208TH St
Kent, WA 98031-4009

Mailing address

10920 SE 208TH St
Kent, WA 98031-4009
Phone (253) 854-1222

Other identifiers 5

IdentifierTypeStateIssuer
DE7654OtherWAREGENCE
5025788MedicaidWA
103746OtherWAL & I
57064OtherWAWDS
5023221MedicaidWA

Other names 1

  • Panther Lake Dental Doing business as

National Provider Directory

National Provider Directory

Locations

10920 SE 208th St
Kent, WA 98031
Phone (253) 852-7331

Practitioners & affiliated clinicians

Practitioners 1

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316010531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10920 SE 208TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980314009",
            "telephone_number": "253-854-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10920 SE 208TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980314009",
            "telephone_number": "253-854-1222",
            "fax_number": "253-859-1269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAY D. DEIGLMEIER DDS. PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEIGLMEIER",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-854-1222",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00007064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "DE7654",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5025788",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "103746",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WDS",
            "identifier": "57064",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5023221",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panther Lake Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.