Provider Demographics
NPI:1285677799
Name:ESPESETH, JANE MALIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MALIN
Last Name:ESPESETH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1708
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-576-1929
Practice Address - Street 1:2825 NE W DEVILS LK RD
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5128
Practice Address - Country:US
Practice Address - Phone:541-994-3033
Practice Address - Fax:541-994-6489
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68191223D0001X
WADE60571710122300000X
ORD9729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health