Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D10655 | OR |
NPI | 1316177199 |
---|---|
Provider Name | Jeremy Claassen |
First Address | Medford, OR 97504 |
Second Address | Medford, OR 97504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 21/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
227698 | (05) | OR |