Individual
DR. JASON RANDALL WHITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1314 NE GRAND AVE, PORTLAND, OR 97232-1127
(503) 280-2877
Mailing address
21743 SW ASPEN PL, TUALATIN, OR 97062-6061
(503) 692-4497
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7755
OR
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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