| Tyack Dental Group | |
|
400 Sw Bel Air Dr Clatskanie OR 97016 | |
| (503) 728-2114 | |
| Not Available |
| Full Name | Tyack Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 400 Sw Bel Air Dr, Clatskanie, Oregon |
| Authorized Official Name and Position | James Hal Tyack (PRESIDENT) |
| Authorized Official Contact | 5037282114 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyack Dental Group Po Box 749 Clatskanie OR 97016-0749 Ph: (503) 728-2114 | Tyack Dental Group 400 Sw Bel Air Dr Clatskanie OR 97016 Ph: (503) 728-2114 |
| NPI Number | 1578587192 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578587192 | NPI | - | NPPES |
| 199372 | Medicaid | OR | |
| 5043146 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D5226 (Oregon) | Primary |
Arrow Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Sw Belair Dr, Clatskanie, OR 97016 Phone: 503-728-2114 |