Healthcare Provider Details

I. General information

NPI: 1336278357
Provider Name (Legal Business Name): DAVID J WASHBURN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 W. UMPQUA ST
ROSEBURG OR
97470
US

IV. Provider business mailing address

544 W. UMPQUA ST
ROSEBURG OR
97470
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-9596
  • Fax: 541-464-3519
Mailing address:
  • Phone: 541-672-9596
  • Fax: 541-464-3519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5509
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: