Healthcare Provider Details

I. General information

NPI: 1124689997
Provider Name (Legal Business Name): JOCELYN LIMERICK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 LANCASTER DR NE
SALEM OR
97301-5155
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 503-576-8350
  • Fax:
Mailing address:
  • Phone: 509-865-2395
  • Fax: 509-865-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-5056
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12074
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: