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General NPI Number Information
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NPI Number | 1962640771
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Entity Type | Organization
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Legal Business Name | JACOB O. LAYER, DMD, PC
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 1485 E MCANDREWS RD
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City | MEDFORD
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State | OR
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Zip | 97504-6107
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Country | US
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Telephone | 541-734-0970
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Fax | 541-734-2081
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Provider Business Mailing Address
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Address Line | 1485 E MCANDREWS RD
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City | MEDFORD
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State | OR
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Zip | 97504-6107
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Country | US
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Telephone | 541-734-0970
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Fax | 541-734-2081
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB O LAYER
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Credential | DMD
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Telephone | 541-734-0970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D8284
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License Number State | OR
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