Individual provider Active NPI

Jennifer M Williams Driver, DMD

  • General Practice Dentistry
  • Roseburg, OR
National Provider Identifier
1144452004
Registry record updated Jun 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9453 Issued in OR
Practice address
1651 NW Hughwood CT
Roseburg, OR 97471-8834
Phone
(541) 672-8187
Fax
(541) 672-0224
NPI assigned
Aug 11, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D4251 ID
General Practice Dentistry 1223G0001X D9453 OR Primary

Addresses

Primary practice location

1651 NW Hughwood CT
Roseburg, OR 97471-8834

Mailing address

299 Hidden Valley LN
Roseburg, OR 97471-8255
Phone (208) 866-6907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D4251IDMDDentist
D9453ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Driver & Driver PC, Dba Driver Dentistry General Practice CurrentSince Aug 2, 2020 Accepting new patients
Mark R Driver DMD PC General Practice Past Accepting new patients

Locations

1651 NW Hughwood Ct
Roseburg, OR 97471
Phone (541) 672-8187

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307664000000",
    "number": "1144452004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 HIDDEN VALLEY LN",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718255",
            "telephone_number": "208-866-6907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 NW HUGHWOOD CT",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974718834",
            "telephone_number": "541-672-8187",
            "fax_number": "541-672-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS DRIVER",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-11",
        "last_updated": "2011-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D4251",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.