Active NPI
Jean M Pacewic
- Dentist
- West Linn, OR
National Provider Identifier
1174715197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9278
- Practice address
- 1554 Garden St Ste 104
West Linn, OR 97068-3278 - Phone
- (503) 655-9300
- Fax
- (503) 212-0122
- NPI assigned
- Aug 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9278 | OR | Primary |
Addresses
Primary practice location
1554 Garden St Ste 104
West Linn, OR 97068-3278
Mailing address
1554 Garden St Ste 104
West Linn, OR 97068-3278
Phone (503) 655-9300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110720000686 | OR | Order and Referring Only - Oral Surgery | 9537337456 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9278 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776816000000",
"number": "1174715197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1554 GARDEN ST STE 104",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970683278",
"telephone_number": "503-655-9300",
"fax_number": "503-212-0122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1554 GARDEN ST STE 104",
"city": "WEST LINN",
"state": "OR",
"postal_code": "970683278",
"telephone_number": "503-655-9300",
"fax_number": "503-212-0122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACEWIC",
"first_name": "JEAN",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-14",
"last_updated": "2026-04-22",
"certification_date": "2026-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "9278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Linn, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.