Provider Demographics
NPI:1114063542
Name:JEFFREY CARL DMD PC
Entity Type:Organization
Organization Name:JEFFREY CARL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-926-6089
Mailing Address - Street 1:3683 NW GLEN EDEN DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9169
Mailing Address - Country:US
Mailing Address - Phone:541-752-0378
Mailing Address - Fax:
Practice Address - Street 1:917 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4228
Practice Address - Country:US
Practice Address - Phone:541-926-6089
Practice Address - Fax:541-926-6196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD72141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty