Provider Demographics
NPI:1104314558
Name:ACORN DENTISTRY FOR KIDS - HILLSBORO, LLC
Entity type:Organization
Organization Name:ACORN DENTISTRY FOR KIDS - HILLSBORO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-874-4560
Mailing Address - Street 1:411 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1625
Mailing Address - Country:US
Mailing Address - Phone:503-874-4560
Mailing Address - Fax:503-874-4562
Practice Address - Street 1:434 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-3982
Practice Address - Country:US
Practice Address - Phone:503-874-4560
Practice Address - Fax:503-874-4562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9577261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental