MEDICARE: JEFFREY CARL DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D7214	OR

General Provider Information

NPI Number	:	1114063542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY CARL DMD PC

Provider Business Mailing Address
First Line	:	3683 NW GLEN EDEN DR
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-9169
Country	:	US
Telephone Number	:	541-752-0378
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 19TH AVE SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-4228
Country	:	US
Telephone Number	:	541-926-6089
Fax Number	:	541-926-6196

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY D CARL
Credential	:	DMD
Telephone Number	:	541-926-6089

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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