Organization
TIGARD FAMILY DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA ANN MARTINEZ (OFFICE MANAGER)
(503) 968-2901
Entity
Organization
Contact information
Practice address
11820 SW KING JAMES PL STE 20, TIGARD, OR 97224-2481
(503) 620-2020
Mailing address
11820 SW KING JAMES PL STE 20, TIGARD, OR 97224-2481
(503) 620-2020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7467
OR
Other
Enumeration date
03/17/2011
Last updated
11/28/2012
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