MEDICARE: JENNIFER L HOUGH DMD PLLC

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	261QD0000X	Dental Clinic/Center	7268	WA

General Provider Information

NPI Number	:	1669819769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER L HOUGH DMD PLLC

Provider Business Mailing Address
First Line	:	2016 NE 3RD AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-1705
Country	:	US
Telephone Number	:	360-834-3533
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 NE 3RD AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-1705
Country	:	US
Telephone Number	:	360-834-3533
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JENNIFER LYNN HOUGH
Credential	:	D.M.D.
Telephone Number	:	360-834-3533

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	05/29/2013

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