Provider Demographics
NPI:1962640771
Name:JACOB O. LAYER, DMD, PC
Entity Type:Organization
Organization Name:JACOB O. LAYER, DMD, PC
Other - Org Name:JACOB O. LAYER FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:O
Authorized Official - Last Name:LAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-734-0970
Mailing Address - Street 1:1485 E MCANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6107
Mailing Address - Country:US
Mailing Address - Phone:541-734-0970
Mailing Address - Fax:541-734-2081
Practice Address - Street 1:1485 E MCANDREWS RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6107
Practice Address - Country:US
Practice Address - Phone:541-734-0970
Practice Address - Fax:541-734-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8284261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental