Individual
JACOB R KAUFMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
12596 SE STARK ST BLDG N, PORTLAND, OR 97233-1056
(503) 252-9657
Mailing address
7045 NE DAVIS ST, PORTLAND, OR 97213-5629
(503) 476-7660
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11315
OR
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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