TYLER BRADSTREET
Individual Provider (NPI-1)
Active
Dentist, General Practice
Provider Information
- NPI Number
1699126532- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 23479 SE STARK ST STE. 102, GRESHAM, OR, 970302962
- Phone
- (503) 667-1184
Specialties & Taxonomies
Dentist, General Practice
Primary License: OR #D10466