Eastridge Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9467 Issued in WA

Legal business name

EASTRIDGE FAMILY DENTAL

Practice address

24837 104TH Ave SE
103
Kent, WA 98030-6800

Phone

(253) 277-2620

Fax

(253) 277-2659

NPI assigned

May 9, 2014

Organization subpart

No

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

Authorized official

Name

Jayanthi Bantwal, D.D.SNPI 1699890335

Title

Dentist

Phone

(253) 277-2620

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jayanthi Bantwal, DDS

  • Dentist
  • Kent, WA
  • NPI 1699890335
  NPD (past) Authorized official

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

{
    "created_epoch": "1399593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399593600000",
    "number": "1700297967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24837 104TH AVE SE",
            "address_2": "103",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306800",
            "telephone_number": "253-277-2620",
            "fax_number": "253-277-2659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24837 104TH AVE SE",
            "address_2": "103",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306800",
            "telephone_number": "253-277-2620",
            "fax_number": "253-277-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTRIDGE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-09",
        "last_updated": "2014-05-09",
        "status": "A",
        "authorized_official_last_name": "BANTWAL",
        "authorized_official_first_name": "JAYANTHI",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "253-277-2620",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "9467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• East Hill Medical Clinic
• East Hill Optometry
• Easthill Medical Clinic LLC
• Phylliss Marie Eberhardy, MS LMFT CCDCI
• Stacey Eberly
• Richard E. Eccles, M.D.
• Kiana Ecclestone
• Chukwudi Ede

• General Practice Dentistry in Kent, WA
• Providers in Kent, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2014; 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.