Provider Demographics
NPI:1447554597
Name:JANSEN, SHERRY M (RDH)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:M
Last Name:JANSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 FARALLONE AVE
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-7110
Mailing Address - Country:US
Mailing Address - Phone:253-651-1360
Mailing Address - Fax:
Practice Address - Street 1:11582 C CT.
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS-MC CHORD
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-966-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHL60393178124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist