Individual
JOSE LUIS JAVIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2084 NE PROFESSIONAL CT, BEND, OR 97701
(541) 383-3005
Mailing address
PO BOX 4228, PORTLAND, OR 97208-4228
(554) 383-3005
(541) 383-1883
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9037
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33735200
—
WI
Enumeration date
09/20/2006
Last updated
07/25/2024
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