Individual
VAUGHN G TIDWELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2236 PACIFIC AVE, FOREST GROVE, OR 97116-2448
(503) 359-5481
(503) 359-7882
Mailing address
2236 PACIFIC AVE, FOREST GROVE, OR 97116-2448
(503) 359-5481
(503) 359-7882
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5848
OR
Other
Enumeration date
09/27/2005
Last updated
07/08/2007
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