1134825896 NPI number — DR. JACQUELINE RYAN THROWER DMD, MS, MPA

Table of content: DR. JACQUELINE RYAN THROWER DMD, MS, MPA (NPI 1134825896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134825896 NPI number — DR. JACQUELINE RYAN THROWER DMD, MS, MPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THROWER
Provider First Name:
JACQUELINE
Provider Middle Name:
RYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD, MS, MPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNCAN
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
RYAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134825896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4926 SW VIEW POINT TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239-4079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-830-9966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 SW VERMONT ST STE O
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97219-1945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-246-9802
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  D11733 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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