Provider Demographics
NPI:1134825896
Name:THROWER, JACQUELINE RYAN (DMD, MS, MPA)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RYAN
Last Name:THROWER
Suffix:
Gender:F
Credentials:DMD, MS, MPA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:RYAN
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4926 SW VIEW POINT TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4079
Mailing Address - Country:US
Mailing Address - Phone:870-830-9966
Mailing Address - Fax:
Practice Address - Street 1:1820 SW VERMONT ST STE O
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1945
Practice Address - Country:US
Practice Address - Phone:503-246-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD117331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics