Provider Demographics
NPI:1336278357
Name:WASHBURN, DAVID J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 W. UMPQUA ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470
Mailing Address - Country:US
Mailing Address - Phone:541-672-9596
Mailing Address - Fax:541-464-3519
Practice Address - Street 1:544 W. UMPQUA ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470
Practice Address - Country:US
Practice Address - Phone:541-672-9596
Practice Address - Fax:541-464-3519
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR55091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR009352000OtherBLUE CROSS OF OR
OR917114OtherUNITED CONCORDIA