Individual
JEREMY RYAN VISTICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401417561
VA
122300000X
Dentist
D8993
OR
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
109231
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500637605
—
OR
Enumeration date
10/16/2007
Last updated
10/01/2024
Update your record
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