Provider Demographics
NPI:1942588215
Name:PRIESS, JUSTINE JORDAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:JORDAN
Last Name:PRIESS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JUSTINE
Other - Middle Name:ELIZABETH
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14315 62ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8664
Mailing Address - Country:US
Mailing Address - Phone:253-851-4025
Mailing Address - Fax:253-295-4253
Practice Address - Street 1:14315 62ND AVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332
Practice Address - Country:US
Practice Address - Phone:253-851-4025
Practice Address - Fax:253-295-4253
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA606440751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice