Organization
TIGARD DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON J WHEELER DDS (OWNER)
(503) 684-9017
Entity
Organization
Contact information
Practice address
12720 SW PACIFIC HWY STE 2, TIGARD, OR 97223-6125
(503) 684-9017
Mailing address
12720 SW PACIFIC HWY STE 2, TIGARD, OR 97223-6125
(503) 684-9017
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7862
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205049251
NPI
—
Enumeration date
06/06/2007
Last updated
08/22/2020
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