Organization
VAUGHN GRAY TIDWELL DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAUGHN GRAY TIDWELL DMD, FICOI (OWNER)
(503) 359-5481
Entity
Organization
Contact information
Practice address
2236 PACIFIC AVE, SUITE A, FOREST GROVE, OR 97116-2448
(503) 359-5481
(503) 359-7882
Mailing address
2236 PACIFIC AVE, FOREST GROVE, OR 97116-2448
(503) 359-5481
(503) 359-7882
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5848
OR
Other
Enumeration date
06/23/2008
Last updated
06/23/2008
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