Provider Demographics
NPI:1962278242
Name:AMES BOYACK DESPAIN PLLC
Entity type:Organization
Organization Name:AMES BOYACK DESPAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:A
Authorized Official - Last Name:DESPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-430-8578
Mailing Address - Street 1:150 W SEQUIM BAY RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8406
Mailing Address - Country:US
Mailing Address - Phone:360-565-5066
Mailing Address - Fax:360-504-2237
Practice Address - Street 1:512 E WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3598
Practice Address - Country:US
Practice Address - Phone:360-681-6834
Practice Address - Fax:360-681-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental