Healthcare Provider Details

I. General information

NPI: 1316177199
Provider Name (Legal Business Name): JEREMY CLAASSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 ROYAL CT
MEDFORD OR
97504
US

IV. Provider business mailing address

906 ROYAL COURT
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-414-0519
  • Fax: 541-842-7774
Mailing address:
  • Phone: 541-414-0519
  • Fax: 541-842-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD10655
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: