Healthcare Provider Details

I. General information

NPI: 1689748410
Provider Name (Legal Business Name): JOHN PHILLIP HOUGHTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 E MCANDREWS SUITE A
MEDFORD OR
97504
US

IV. Provider business mailing address

1762 E MCANDREWS SUITE A
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-5111
  • Fax: 541-773-5551
Mailing address:
  • Phone: 541-779-5111
  • Fax: 541-773-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD5002
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: