Individual
JACK R ELVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTURIST
Contact information
Practice address
1113 HILL ST SE, ALBANY, OR 97322-3295
(541) 928-1955
Mailing address
1645 9TH AVE SE, #286, ALBANY, OR 97322-4872
(541) 928-1955
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-609564
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071696
—
OR
Enumeration date
01/10/2007
Last updated
07/08/2007
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