Healthcare Provider Details

I. General information

NPI: 1902362791
Provider Name (Legal Business Name): JESSICA DODGE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PEARL ST
EUGENE OR
97401-4009
US

IV. Provider business mailing address

341 E 12TH AVE
EUGENE OR
97401-3212
US

V. Phone/Fax

Practice location:
  • Phone: 360-513-5596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10972
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10972
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: