Healthcare Provider Details

I. General information

NPI: 1477279040
Provider Name (Legal Business Name): JENNIFER FURGISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MINNIS

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30470 SW PARKWAY AVE STE 101A
WILSONVILLE OR
97070-7954
US

IV. Provider business mailing address

2331 MISTY GLEN AVE NW
SALEM OR
97304-1494
US

V. Phone/Fax

Practice location:
  • Phone: 503-610-6783
  • Fax:
Mailing address:
  • Phone: 503-800-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH8691
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: