Provider Demographics
NPI:1346376225
Name:JANAKIEVSKI, JIM (DDS MSD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:JANAKIEVSKI
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 S 19TH ST
Mailing Address - Street 2:101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-752-6622
Mailing Address - Fax:253-756-5875
Practice Address - Street 1:4050 S 19TH ST
Practice Address - Street 2:101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-752-6622
Practice Address - Fax:253-756-5875
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000100501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics