Individual
JEFFREY JACKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DENTURIST LD
Contact information
Practice address
4925 SW GRIFFITH DR, BEAVERTON, OR 97005-2923
(855) 433-6825
Mailing address
6950 NE CAMPUS WAY, HILLSBORO, OR 97124-5611
(855) 433-6825
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DTDO709602
OR
Other
Enumeration date
06/17/2016
Last updated
06/26/2023
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