Basic Information
| Provider Information | |||||||||
| NPI: | 1538725544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OBERMILLER | ||||||||
| FirstName: | JONNA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 LINCOLN STREET,2ND FLOOR, ATTN: CREDENTIALS OFFICE | ||||||||
| Address2: | US ARMY DENTAC | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539684079 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | US ARMY DENTAC | ||||||||
| Address2: | 9900 LINCOLN STREET 2ND FLOOR | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536984079 | ||||||||
| FaxNumber: | 2539685919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2019 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | WA | Y | Dental Providers | Dental Hygienist |
No ID Information.