Individual
TYLER GIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1025 VEY WAY, THE DALLES, OR 97058-1066
(541) 370-7120
Mailing address
1025 VEY WAY, THE DALLES, OR 97058-1066
(541) 370-7120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11992
OR
Other
Enumeration date
04/18/2017
Last updated
07/13/2024
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