Provider Demographics
NPI:1417307513
Name:JENNIFER MCLEOD, DMD, PC
Entity Type:Organization
Organization Name:JENNIFER MCLEOD, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-332-8118
Mailing Address - Street 1:615 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3100
Mailing Address - Country:US
Mailing Address - Phone:503-538-7717
Mailing Address - Fax:503-538-7727
Practice Address - Street 1:615 E 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3100
Practice Address - Country:US
Practice Address - Phone:503-538-7717
Practice Address - Fax:503-538-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty