Provider Demographics
NPI:1962619874
Name:TUALATIN DENTAL CARE, P.C.
Entity type:Organization
Organization Name:TUALATIN DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-885-8899
Mailing Address - Street 1:8375 SW WARM SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9003
Mailing Address - Country:US
Mailing Address - Phone:503-885-8899
Mailing Address - Fax:503-885-8721
Practice Address - Street 1:8375 SW WARM SPRINGS ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9003
Practice Address - Country:US
Practice Address - Phone:503-885-8899
Practice Address - Fax:503-885-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty