Individual
DR. JAMES HAL TYACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
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
1223G0001X
General Practice Dentistry
DE00007760
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199372
—
OR
05
—
5043146
—
WA
Enumeration date
07/27/2006
Last updated
07/08/2007
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