DR. JACQUELINE D MASSOUDA (NPI# 1336695535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336695535 |
| Entity Type | Individual |
| Full Name | DR. JACQUELINE D MASSOUDA |
| Credential | D.M.D |
| Practice Address |
Jblm Dentac 9900 Lincoln Sreet, 2nd Floor Apo AA 98431 |
| Mailing Address |
Us Army Dentac: Attn Credentials Office 9900 Lincoln Street, 2nd Floor Tacoma WA 98327 |
| Practice Telephone | 5027598448 |
| Practice Fax Number | 2539685919 |
| Mailing Telephone | 2539684079 |
| Mailing Fax Number | 2539685919 |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
9738 | KY | Dental Providers |
| Street Address |
JBLM DENTAC 9900 LINCOLN SREET, 2ND FLOOR |
| City | APO |
| State | AA |
| Zip Code | 98431 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
| 1790036895 | Cynthia L. Alexander | Psychologist | 9933 West Hayes Street, Old Madigan, National Center for Telehealth & Technology (t2), Joint Base Lewis-mcchord, WA 98431 | 2012-09-28 |
| Find all providers in zip 98431 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154938520 | Jacob Steven Blackhurst | Dentist | Bldg 4-1838 Normandy Dr, Apo, AA 28307-7302 | 2020-09-29 |
| 1669088852 | Matthew Dejong | Dentist | Kleber Dental Clinic, Bldg 3287, Apo, AE 09227 | 2020-09-22 |
| 1184236895 | Christina Belousov | Dentist | 14351 Battalion Ave, Apo, AA 76544 | 2020-08-24 |
| 1417503459 | Cooper Pasque | Dentist | 1838 Normandy Dr., Fort Bragg, Apo, AA 28310 | 2019-08-15 |
| 1659927937 | Benjamin Kyunghan Yoon | Dentist | 618th Dental Company, Carius Dental Clinic Unit #15652, Attn: Credentails Coordinator, Apo, AP 96271-5245 | 2019-08-13 |
| 1477108967 | Shane Clay Hoffner | Dentist | 618th Dental Co, Carius Dental Clinic Bldg# P3020, Attn: Credentials Office, Apo, AP 96271-5245 | 2019-08-02 |
| 1740848449 | Samuel Kong Hmong Lo | Dentist | Carius Dental Clinic, Unit 15652, Apo, AP 96271 | 2019-05-29 |
| 1437712130 | Andrea Rose Deese | Dentist | Raf Lakenheath 48 Mdg / Sghc, Unit 5115, Apo, AE 09461-5115 | 2019-04-17 |
| 1871052837 | Ryan Kenny Zarnowski | Dentist | 673 Mdg, 5955 Zeamer Avenue, Jber, Ak 99506, Apo, AA 99506 | 2019-03-18 |
| 1619440922 | Joo Park | Dentist | Cmr 402 Unit 33301, Apo, AE 09180 | 2019-01-09 |
| Find all providers in APO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.