NPI 1104173244

Mayerle & Tydeman, LLC

Organisation Dentist Lake Oswego, OR

Practice location

Address: 14800 Kruse Oaks Blvd STE a, Lake Oswego, OR 97035-8671
Phone: (503) 684-2944
Fax: (503) 624-6335

Authorised official

Name: Ian Stuart Tydeman
Title: Dentist
Phone: (503) 577-3168

Registered specialties (2)

Dentist Primary

Dental Providers Taxonomy 122300000X Licence D6896 (OR)

Other Dentist providers in Oregon →

Dentist

Dental Providers Taxonomy 122300000X Licence D9162 (OR)

Registry record

NPI: 1104173244
Entity type: Organization
NPI issued: 8 Aug 2012
Record last updated: 8 Aug 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.