NPIMap

Organization Active NPI

Mayerle & Tydeman, LLC

  • Dentist
  • Lake Oswego, OR
National Provider Identifier
1104173244
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D6896 Issued in OR
Legal business name
MAYERLE & TYDEMAN, LLC
Practice address
14800 Kruse Oaks Blvd Ste a
Lake Oswego, OR 97035-8671
Phone
(503) 684-2944
Fax
(503) 624-6335
NPI assigned
Aug 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ian Stuart Tydeman, DMDNPI 1689830556
Title
Dentist
Phone
(503) 577-3168

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D6896 OR Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D9162 OR

Addresses

Primary practice location

14800 Kruse Oaks Blvd Ste a
Lake Oswego, OR 97035-8671

Mailing address

14800 Kruse Oaks Blvd Ste a
Lake Oswego, OR 97035-8671
Phone (503) 684-2944

National Provider Directory

National Provider Directory
Tax ID family
Mayerle Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344384000000",
    "number": "1104173244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14800 KRUSE OAKS BLVD STE A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358671",
            "telephone_number": "503-684-2944",
            "fax_number": "503-624-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 KRUSE OAKS BLVD STE A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358671",
            "telephone_number": "503-684-2944",
            "fax_number": "503-624-6335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYERLE & TYDEMAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-08",
        "last_updated": "2012-08-08",
        "status": "A",
        "authorized_official_last_name": "TYDEMAN",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "503-577-3168",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6896",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9162",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.