Organization
JAMES H. TYACK DMD PC
Active
Other names
Tyack Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES HAL TYACK DMD (PRESIDENT)
(503) 728-2114
Entity
Organization
Contact information
Practice address
400 SW BEL AIR DR, CLATSKANIE, OR 97016
(503) 728-2114
Mailing address
PO BOX 749, CLATSKANIE, OR 97016-0749
(503) 728-2114
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5226
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199372
—
OR
05
—
5043146
—
WA
Enumeration date
07/27/2006
Last updated
08/22/2020
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