Provider Demographics
NPI:1366617805
Name:DAUM, GEORGE FRED (DMD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:FRED
Last Name:DAUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 LANCASTER DR NE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2676
Mailing Address - Country:US
Mailing Address - Phone:503-362-8359
Mailing Address - Fax:503-362-8351
Practice Address - Street 1:831 LANCASTER DR NE
Practice Address - Street 2:SUITE #2
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2676
Practice Address - Country:US
Practice Address - Phone:503-362-8359
Practice Address - Fax:503-362-8351
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist