Provider Demographics
NPI:1750413209
Name:DILLON, JASJIT KAUR (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JASJIT
Middle Name:KAUR
Last Name:DILLON
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:BOX 359893
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2499
Mailing Address - Country:US
Mailing Address - Phone:206-744-3189
Mailing Address - Fax:206-744-2810
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359893
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2499
Practice Address - Country:US
Practice Address - Phone:206-744-3189
Practice Address - Fax:206-744-2810
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104411223S0112X
WATR60082310204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8883636Medicare PIN