| Tigard City Dental Pc | |
|
11565 Sw Hall Blvd Ste A Tigard OR 97223-8493 | |
| (503) 620-2131 | |
| (503) 620-0505 |
| Full Name | Tigard City Dental Pc |
|---|---|
| Speciality | Dentist |
| Location | 11565 Sw Hall Blvd, Tigard, Oregon |
| Authorized Official Name and Position | John D Chung (OWNER) |
| Authorized Official Contact | 5036797730 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tigard City Dental Pc 11565 Sw Hall Blvd Ste A Tigard OR 97223-8493 Ph: (503) 620-2131 | Tigard City Dental Pc 11565 Sw Hall Blvd Ste A Tigard OR 97223-8493 Ph: (503) 620-2131 |
| NPI Number | 1184071003 |
|---|---|
| Provider Enumeration Date | 05/20/2016 |
| Last Update Date | 05/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184071003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D6995 (Oregon) | Primary |
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