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General NPI Number Information
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NPI Number | 1134825896
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Entity Type | Individual
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Provider Name | JACQUELINE RYAN THROWER DMD, MS, MPA
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Gender | Female
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 1820 SW VERMONT ST STE O
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City | PORTLAND
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State | OR
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Zip | 97219-1945
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Country | US
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Telephone | 503-246-9802
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Fax |
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Provider Business Mailing Address
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Address Line | 4926 SW VIEW POINT TER
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City | PORTLAND
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State | OR
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Zip | 97239-4079
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Country | US
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Telephone | 870-830-9966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11733
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License Number State | OR
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