JERALD S PRUNER (NPI# 1134234313) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134234313 |
| Entity Type | Individual |
| Full Name | JERALD S PRUNER |
| Practice Address |
1959 Ne Pacific St C212, Box 356340 Seattle WA 98195-6340 |
| Practice Telephone | 2065430065 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DE00010527 | WA | Dental Providers |
| Street Address |
1959 NE PACIFIC ST C212, BOX 356340 |
| City | SEATTLE |
| State | WA |
| Zip Code | 98195-6340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285637298 | Divis Kaur Khaira | Internal Medicine | 1959 Ne Pacific St, Seattle, WA 98195 | 2005-05-23 |
| 1225639628 | Alexandra Christina Schenck | Speech-Language Pathologist | 1959 Ne Pacific St, 3rd Floor, Ne 300, Seattle, WA 98195 | 2020-11-03 |
| 1245831692 | Lindsey Marie Graff | Registered Nurse | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-11-03 |
| 1841891165 | Yip Han Lee | Nurse Anesthetist, Certified Registered | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-11-03 |
| 1003415316 | Thuy Duong Hoang Nguyen | Pharmacist | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-10-19 |
| 1982201968 | Timothy Shan | Pharmacist | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-10-03 |
| 1245847326 | Erika Patterson | Registered Nurse | 1959 Ne Pacific St, Seattle, WA 98195-5063 | 2020-09-23 |
| 1932716032 | Poonam Gill | Registered Nurse | 1959 Ne Pacific St, Seattle, WA 98195-7263 | 2020-09-23 |
| 1962018119 | Vivian Dao | Pharmacist | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-09-22 |
| 1558977843 | Angela Schwartz | Registered Nurse | 1959 Ne Pacific St, Seattle, WA 98195-0001 | 2020-09-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730700741 | Christian Van Rooyen | Student in an Organized Health Care Education/Training Program | 1951 Pacific Street, Seattle, WA 98195 | 2020-04-30 |
| 1720608235 | Alexander John Arnold | Psychiatry & Neurology | 1959 Ne Pacific St, Rr650, Seattle, WA 98195 | 2020-04-24 |
| 1588127138 | Scott Boop | Student in an Organized Health Care Education/Training Program | Department of Neurological Surgery, 1959 Ne Pacific St, Box Number 356470, Seattle, WA 98195 | 2019-04-10 |
| 1275093973 | Elizabeth Grace Knoff Floodeen | Oral & Maxillofacial Surgery | University of Washington Department of Surgery, 1959 Ne Pacific Street, Seattle, WA 98195 | 2019-03-20 |
| 1780174722 | Matias Eduardo Czerwonko Pupi | Student in an Organized Health Care Education/Training Program | 1959 Ne Pacific Street (university of Washington Depart, Seattle, WA 98195 | 2018-05-15 |
| 1235636143 | Caitlin Aiko Harrington | Student in an Organized Health Care Education/Training Program | University of Washington Internal Medicine Residency, Seattle, WA 98195 | 2018-04-07 |
| 1851897243 | Natalie Miller | Student in an Organized Health Care Education/Training Program | University of Washington Medical Center 1959 Ne Pacific, Seattle, WA 98195 | 2018-04-04 |
| 1386140978 | Elena Luisa Pellicer | Student in an Organized Health Care Education/Training Program | Univ of Washington Dept of Obgyn, 1959 Ne Pacific St., Seattle, WA 98195 | 2018-04-02 |
| 1407386824 | Sherry S Wang | Radiology | Uw Radiology, 1959 Ne Pacific Street, Box 357115, Seattle, WA 98195 | 2017-06-18 |
| 1932638137 | Maziar Riazy | Student in an Organized Health Care Education/Training Program | 1959 Ne Pacific Street, Rm Ne110, University of Washington Medical Center - Pathology, Seattle, WA 98195 | 2017-06-09 |
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| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053875096 | John K Tidwell Dds and Elizabeth A Kutcipal Dds Pllc | Dentist | 1801 Nw Market St Ste 108, Seattle, WA 98107-3909 | 2019-01-23 |
| 1780151027 | Washington Jaw and Facial Surgery Pllc | Dentist | 2111 N Northgate Way Ste 105, Seattle, WA 98133-9018 | 2018-10-25 |
| 1952788150 | David J Haralson | Dentist | 509 Olive Way Ste 1331, Seattle, WA 98101-1743 | 2015-04-27 |
| 1912391350 | Li Han Lai | Dentist | Department of Oral Surgery 1959 Ne Pacific St, Health Sciences Building B-241, Seattle, WA 98195-0001 | 2015-03-24 |
| 1568693240 | Todd Paul Fairbanks | Dentist | University of Washington Oral Surgery Dept, Box 357134, 1959 Ne Pacific St., Seattle, WA 98195-7134 | 2009-07-29 |
| 1720292436 | Samuel Louis Bobek | Dentist | 600 Broadway Ste 460, Seattle, WA 98122-5312 | 2007-05-10 |
| 1669522546 | Thomas Stuart Maring | Dentist | 509 Olive Way Ste 550, Seattle, WA 98101-1736 | 2007-01-11 |
| 1093882185 | Darlene Michelle Chan | Dentist | 4744 41st Ave Sw Suite 107, Seattle, WA 98116-4566 | 2006-11-30 |
| 1750387361 | Thomas Howard Hohl | Dentist | 4540 Sand Point Way Ne, Ste 360, Seattle, WA 98105 | 2005-06-28 |
| 1750842415 | Brian H. Cheung, Dds, Md, Pllc | Dentist | 509 Olive Way Ste 1331, Seattle, WA 98101-1743 | 2019-03-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.