MEDICARE: JESSICA BUENJEMIA DDS

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	D8493	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710967336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BUENJEMIA DDS

Provider Business Mailing Address
First Line	:	1001 SE TUALATIN VALLEY HWY
Second Line	:	STE A16
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4977
Country	:	US
Telephone Number	:	503-693-1217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2157 BROADWAY ST
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2329
Country	:	US
Telephone Number	:	541-751-1915
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	12/29/2016

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