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General NPI Number Information
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NPI Number | 1164384442
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Entity Type | Organization
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Legal Business Name | JAB DENTAL LLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 30045 SW PARKWAY AVE
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City | WILSONVILLE
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State | OR
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Zip | 97070-9735
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Country | US
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Telephone | 503-682-2455
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Fax | 503-570-8522
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Provider Business Mailing Address
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Address Line | 30045 SW PARKWAY AVE
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City | WILSONVILLE
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State | OR
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Zip | 97070-9735
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Country | US
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Telephone | 503-682-2455
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Fax | 503-570-8522
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. JASON BAJUSCAK
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Credential | DMD
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Telephone | 541-852-5812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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