Provider Demographics
NPI:1801350194
Name:OSTRANDER, JESSICA MARIE (RDH EPP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:OSTRANDER
Suffix:
Gender:F
Credentials:RDH EPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38968 HILLS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-8550
Mailing Address - Country:US
Mailing Address - Phone:541-968-9147
Mailing Address - Fax:
Practice Address - Street 1:1275 S RIVER RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-3906
Practice Address - Country:US
Practice Address - Phone:541-942-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6798124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist