Individual
DORIE J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2811 MAIN ST, PHILOMATH, OR 97370-9245
(541) 929-5227
Mailing address
1899 BOBCAT AVE SW, ALBANY, OR 97321-4870
(541) 979-5629
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H5812
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H5812
LICENCE
OR
Enumeration date
07/17/2018
Last updated
07/17/2018
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