Individual
JESSE R GRIDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1885 WAITE ST, NORTH BEND, OR 97459-1210
(541) 756-1117
(541) 756-3811
Mailing address
1885 WAITE ST, NORTH BEND, OR 97459-1210
(541) 756-1117
(541) 756-3811
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D9466
OR
Other
Enumeration date
11/01/2010
Last updated
11/01/2010
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