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Individual

DR. JED RYAN NORMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1813 W HARVARD STE 221, ROSEBURG, OR 97471
(541) 672-6511
(541) 673-1892
Mailing address
1813 W HARVARD STE 221, ROSEBURG, OR 97471
(541) 672-6511
(541) 673-1892

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D3831
ID
1223G0001X
General Practice Dentistry
Primary
D8859
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
278647
OR
05
806926400
ID
Enumeration date
06/06/2006
Last updated
06/04/2013
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