Stauffer, Jacy A.

Stauffer, Jacy A. is an individual health care provider with primary practice located at 3181 Sw Sam Jackson Park Rd , Portland OR 97239-3011. She recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as her primary health care specialty. Stauffer, Jacy A. can be contacted via phone (503) 418-5799.

Contact Information

Primary practice address
3181 Sw Sam Jackson Park Rd Portland OR 97239-3011
Phone: (503) 418-5799
Fax: (503) 418-4750
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X LL738 Maryland
Dental Providers / Pediatric Dentistry 1223P0221X DF0053 Oregon

Profile Details

NPI number 1699974014
LBN Legal business name Stauffer, Jacy A.
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 16th, 2007
Last updated Nov 10th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699974014 NPPES
Maryland MEDICAID 119591300

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