DR. JEFFERSON B GOURLEY (NPI# 1003941170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1003941170 |
Entity Type | Individual |
Full Name | DR. JEFFERSON B GOURLEY |
Credential | DDS |
Practice Address |
142 Pembrook St Se Salem OR 97302-5038 |
Mailing Address |
6950 Ne Campus Way Hillsboro OR 97124-5611 |
Practice Telephone | 8554336825 |
Mailing Telephone | 8554336825 |
Enumeration Date | 2007-02-22 |
Last Update Date | 2019-03-05 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 1223E0200X |
Dentist Specialization: Endodontics |
DE60502349 | WA | Dental Providers |
Y | 1223E0200X |
Dentist Specialization: Endodontics |
D11009 | OR | Dental Providers |
Street Address |
142 PEMBROOK ST SE |
City | SALEM |
State | OR |
Zip Code | 97302-5038 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508352931 | Troy Michael Heisch | Dentist | 142 Pembrook St Se, Salem, OR 97302 | 2018-07-09 |
1508389586 | Leif Joseph Gambee | Dentist | 142 Pembrook St Se, Salem, OR 97302-5038 | 2017-07-20 |
1194248427 | Emmy Cristina Garcia | Dentist | 142 Pembrook St Se, Salem, OR 97302-5038 | 2017-07-19 |
1134675580 | Natalija Kokoreva | Dentist | 142 Pembrook St Se, Salem, OR 97302 | 2016-08-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
Find all providers in zip 97302 |
Taxonomy Code | 1223E0200X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Endodontics |
The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
Notes: Source: Council on Dental Education and Licensure, American Dental Association |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386069151 | Tcd Endodontics | Dentist | 620 12th St. Se, Salem, OR 97301 | 2014-03-03 |
1811088222 | Lisa Beth Wipf | Dentist | 3389 Center St Ne, Salem, OR 97301 | 2006-09-28 |
1730198359 | Endodontics Inc | Dentist | 2 Winter St, Salem, MA 01970-3807 | 2006-08-05 |
1457369969 | Chris J Bowman | Dentist | 830 Liberty St Ne, Salem, OR 97301-2450 | 2006-08-03 |
1316962913 | Marvin E. Thews Jr. | Dentist | 1940 Braeburn Dr, Salem, VA 24153-7383 | 2006-07-13 |
1891789376 | Kevin Roy Christiansen | Dentist | 4342 Liberty Rd S, Salem, OR 97302-6171 | 2005-09-09 |
1922647312 | - | Dentist | 4342 Liberty Rd S, Salem, OR 97302-6171 | 2020-01-02 |
1558779579 | David Cheung-fai Lau | Dentist | 620 12th St. Se, Salem, OR 97301 | 2014-07-23 |
1801216643 | Willamette Valley Endodontics, PC | Dentist | 805 High St Ne, Salem, OR 97301-2442 | 2014-04-20 |
1881969244 | Salem Endodontic Associates | Dentist | 4342 Liberty Rd S, Salem, OR 97302-6171 | 2012-03-19 |
Find all providers in SALEM |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.