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VAUGHN GRAY TIDWELL DMD PC NPI 1578724407


NPI Information

NPI: 1578724407
Provider Name: VAUGHN GRAY TIDWELL DMD PC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
2236 PACIFIC AVE
SUITE A
FOREST GROVE, OR
ZIP 97116
Phone: (503) 359-5481
Get Directions

VAUGHN GRAY TIDWELL DMD PC is a general practice dentist in Forest Grove, OR. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. VAUGHN GRAY TIDWELL DMD PC NPI is 1578724407. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2236 PACIFIC AVE
SUITE A
FOREST GROVE, OR
ZIP 97116-448
Phone: (503) 359-5481
Fax: (503) 359-7882

The provider's authorized official is Vaughn Gray Tidwell .
The authorized official title is Owner and has the following contact phone number (503) 359-5481.

The enumeration date for this NPI number is 6/23/2008 and was last updated on 6/23/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice5848OREGONYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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