Individual
MR. JASON DONALD MECUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DHAT
Contact information
Practice address
630 MILUK DR, COOS BAY, OR 97420-7728
(541) 888-9494
Mailing address
PO BOX 3190, COOS BAY, OR 97420-0407
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
18-TDT-02
WA
Other
Enumeration date
08/11/2021
Last updated
08/11/2021
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