MEDICARE: JEAN M PACEWIC

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	122300000X	Dentist	9278	OR

General Provider Information

NPI Number	:	1174715197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M PACEWIC

Provider Business Mailing Address
First Line	:	1554 GARDEN ST STE 104
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3278
Country	:	US
Telephone Number	:	503-655-9300
Fax Number	:	503-212-0122

Provider Business Practice Location Address
First Line	:	1554 GARDEN ST STE 104
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3278
Country	:	US
Telephone Number	:	503-655-9300
Fax Number	:	503-212-0122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	04/22/2026

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Directions to “ JEAN M PACEWIC ” Practice Location

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