Provider Demographics
NPI:1194896548
Name:TENHULZEN, DAVID ROSS (MD DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROSS
Last Name:TENHULZEN
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Gender:M
Credentials:MD DMD
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Mailing Address - Street 1:6464 SW BORLAND RD
Mailing Address - Street 2:STE D3
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062
Mailing Address - Country:US
Mailing Address - Phone:503-692-5654
Mailing Address - Fax:503-692-9220
Practice Address - Street 1:6464 SW BORLAND RD
Practice Address - Street 2:STE D3
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062
Practice Address - Country:US
Practice Address - Phone:503-692-5654
Practice Address - Fax:503-692-9220
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORD63141223S0112X
ORMD13968204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery