Healthcare Provider Details

I. General information

NPI: 1992807218
Provider Name (Legal Business Name): JENNIFER EVA CAMPBELL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER EVA WOODWARD RDH

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

411 NW 10TH ST
PENDLETON OR
97801-1357
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax:
Mailing address:
  • Phone: 541-276-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4174
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: