Organization
CORVALLIS FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN D TIDWELL D.D.S (DENTIST)
(541) 929-5227
Entity
Organization
Contact information
Practice address
1829 NW KINGS BLVD, CORVALLIS, OR 97330-1907
(541) 752-5048
(541) 752-9213
Mailing address
1829 NW KINGS BLVD, CORVALLIS, OR 97330-1907
(541) 752-5048
(541) 752-9213
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
OR
Other
Enumeration date
01/06/2012
Last updated
01/06/2012
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