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General NPI Number Information
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NPI Number | 1114063542
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Entity Type | Organization
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Legal Business Name | JEFFREY CARL DMD PC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 917 19TH AVE SE
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City | ALBANY
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State | OR
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Zip | 97322-4228
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Country | US
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Telephone | 541-926-6089
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Fax | 541-926-6196
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Provider Business Mailing Address
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Address Line | 3683 NW GLEN EDEN DR
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City | CORVALLIS
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State | OR
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Zip | 97330-9169
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Country | US
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Telephone | 541-752-0378
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY D CARL
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Credential | DMD
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Telephone | 541-926-6089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D7214
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License Number State | OR
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