| Vaughn Gray Tidwell Dmd Pc | |
|
2236 Pacific Ave Suite A Forest Grove OR 97116-2448 | |
| (503) 359-5481 | |
| (503) 359-7882 |
| Full Name | Vaughn Gray Tidwell Dmd Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2236 Pacific Ave, Forest Grove, Oregon |
| Authorized Official Name and Position | Vaughn Gray Tidwell (OWNER) |
| Authorized Official Contact | 5033595481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vaughn Gray Tidwell Dmd Pc 2236 Pacific Ave Forest Grove OR 97116-2448 Ph: (503) 359-5481 | Vaughn Gray Tidwell Dmd Pc 2236 Pacific Ave Suite A Forest Grove OR 97116-2448 Ph: (503) 359-5481 |
| NPI Number | 1578724407 |
|---|---|
| Provider Enumeration Date | 06/23/2008 |
| Last Update Date | 06/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578724407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5848 (Oregon) | Primary |
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