Provider Demographics
NPI:1063191245
Name:EID, JABER, JASSAR PLLC
Entity type:Organization
Organization Name:EID, JABER, JASSAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-636-1900
Mailing Address - Street 1:1717 OLYMPIA WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3929
Mailing Address - Country:US
Mailing Address - Phone:360-636-1900
Mailing Address - Fax:360-636-7317
Practice Address - Street 1:926 S 348TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7021
Practice Address - Country:US
Practice Address - Phone:360-636-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EID, JABER, JASSAR PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty