Provider Demographics
NPI:1639915804
Name:CHOUFANI, JEAN-MARC EDOUARD (BDS, MSC)
Entity type:Individual
Prefix:
First Name:JEAN-MARC
Middle Name:EDOUARD
Last Name:CHOUFANI
Suffix:
Gender:M
Credentials:BDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MARTIN LUTHER KING JR WAY S # 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4819
Mailing Address - Country:US
Mailing Address - Phone:857-205-1331
Mailing Address - Fax:
Practice Address - Street 1:620 N EMERSON AVE STE 205
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6619
Practice Address - Country:US
Practice Address - Phone:857-205-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE615475121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty