Provider Demographics
NPI:1609878172
Name:EYRE, JAMES M JR (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:EYRE
Suffix:JR
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:WILLAMETTE VALLEY
Other - Middle Name:ORAL & MAXILLOFACIAL
Other - Last Name:SURGERY, INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:250 CHURCH ST SE
Mailing Address - Street 2:STE 102
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8500
Mailing Address - Country:US
Mailing Address - Phone:503-581-1999
Mailing Address - Fax:503-581-1107
Practice Address - Street 1:250 CHURCH ST SE
Practice Address - Street 2:STE 102
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8500
Practice Address - Country:US
Practice Address - Phone:503-581-1999
Practice Address - Fax:503-581-1107
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG76082Medicare UPIN
OR107598Medicare ID - Type Unspecified