Jack Edward Ehlen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6157 Issued in WA

Practice address

11208 B 94TH Ave E
Puyallup, WA 98373-3663

Phone

(253) 848-4597

Fax

(253) 841-7677

NPI assigned

Mar 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356474191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11208 B 94TH AVE E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733663",
            "telephone_number": "253-848-4597",
            "fax_number": "253-841-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11208 B 94TH AVE E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733663",
            "telephone_number": "253-848-4597",
            "fax_number": "253-841-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHLEN",
        "first_name": "JACK",
        "middle_name": "EDWARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "6157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meagan Edwards
• Amy Florence Egbert
• Stephen M. Egge, M.D.
• Mary Eggert
• Ehlen & Fuller DDS PLLC
• Devin Joseph Ehli, DPT
• Jessica Eickhoff, MS, CCC-SLP
• Candy Monkengo Ekamba
• Sancar Eke, M.D.
• Bettina Kathleen Eklund, COTA/L

• Dentist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.