| Mayerle & Tydeman, Llc | |
|
14800 Kruse Oaks Blvd Ste A Lake Oswego OR 97035-8671 | |
| (503) 684-2944 | |
| (503) 624-6335 |
| Full Name | Mayerle & Tydeman, Llc |
|---|---|
| Speciality | Dentist |
| Location | 14800 Kruse Oaks Blvd Ste A, Lake Oswego, Oregon |
| Authorized Official Name and Position | Ian Stuart Tydeman (DENTIST) |
| Authorized Official Contact | 5035773168 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mayerle & Tydeman, Llc 14800 Kruse Oaks Blvd Ste A Lake Oswego OR 97035-8671 Ph: (503) 684-2944 | Mayerle & Tydeman, Llc 14800 Kruse Oaks Blvd Ste A Lake Oswego OR 97035-8671 Ph: (503) 684-2944 |
| NPI Number | 1104173244 |
|---|---|
| Provider Enumeration Date | 08/08/2012 |
| Last Update Date | 08/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104173244 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D6896 (Oregon) | Primary |
| 122300000X | Dentist | D9162 (Oregon) | Secondary |
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