Organization
MAYERLE & TYDEMAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN STUART TYDEMAN DMD (DENTIST)
(503) 577-3168
Entity
Organization
Contact information
Practice address
14800 KRUSE OAKS BLVD STE A, LAKE OSWEGO, OR 97035-8671
(503) 684-2944
(503) 624-6335
Mailing address
14800 KRUSE OAKS BLVD STE A, LAKE OSWEGO, OR 97035-8671
(503) 684-2944
(503) 624-6335
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6896
OR
122300000X
Dentist
D9162
OR
Other
Enumeration date
08/08/2012
Last updated
08/08/2012
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