Vaughn Gray Tidwell Dmd PC
NPI #1578724407 in Forest Grove, Oregon
Provider Information
- NPI Number
- 1578724407
- Entity Type
- Organization
- Organization Name
- Vaughn Gray Tidwell Dmd PC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jun 23, 2008
- Last Updated
- Jun 23, 2008
Practice Location
- Address
- 2236 PACIFIC AVE
- Address 2
- SUITE A
- City
- Forest Grove
- State
- Oregon
- ZIP Code
- 97116-2448
- Phone
- (503) 359-5481
Authorized Official
- Name
- DR. VAUGHN GRAY TIDWELL, DMD, FICOI
- Title
- OWNER
- Phone
- (503) 359-5481
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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