Provider Demographics
NPI:1730511148
Name:IRWIN, JESSICA E (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:E
Last Name:IRWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 SW CEDAR HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4513
Mailing Address - Country:US
Mailing Address - Phone:503-644-4749
Mailing Address - Fax:503-644-1659
Practice Address - Street 1:2375 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-4513
Practice Address - Country:US
Practice Address - Phone:503-644-7479
Practice Address - Fax:503-644-1659
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20329122300000X
ORD107731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist