Individual
JESSICA DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2074 S 6TH ST, KLAMATH FALLS, OR 97601-3372
(541) 851-8110
Mailing address
2074 S 6TH ST, KLAMATH FALLS, OR 97601-3372
(541) 851-8110
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10972
OR
1223G0001X
General Practice Dentistry
D10972
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500763061
—
OR
Enumeration date
02/16/2019
Last updated
03/01/2021
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