Organization
TIGARD CITY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D CHUNG DDS (OWNER)
(503) 679-7730
Entity
Organization
Contact information
Practice address
11565 SW HALL BLVD, STE A, TIGARD, OR 97223-8493
(503) 620-2131
(503) 620-0505
Mailing address
11565 SW HALL BLVD, STE A, TIGARD, OR 97223-8493
(503) 620-2131
(503) 620-0505
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D6995
OR
Other
Enumeration date
05/20/2016
Last updated
05/20/2016
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