NPIMap

Organization Active NPI

Vaughn Gray Tidwell DMD PC

  • General Practice Dentistry
  • Forest Grove, OR
National Provider Identifier
1578724407
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5848 Issued in OR
Legal business name
VAUGHN GRAY TIDWELL DMD PC
Practice address
2236 Pacific Ave
Suite a
Forest Grove, OR 97116-2448
Phone
(503) 359-5481
Fax
(503) 359-7882
NPI assigned
Jun 23, 2008
Last updated
Jun 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Dr. Vaughn Gray Tidwell, DMD, FICOINPI 1083600753
Title
Owner
Phone
(503) 359-5481

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5848 OR Primary

Addresses

Primary practice location

2236 Pacific Ave
Suite a
Forest Grove, OR 97116-2448

Mailing address

2236 Pacific Ave
Forest Grove, OR 97116-2448
Phone (503) 359-5481

National Provider Directory

National Provider Directory

Locations

2236 Pacific Ave
Ste A
Forest Grove, OR 97116
Phone (503) 359-5481

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1578724407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2236 PACIFIC AVE",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162448",
            "telephone_number": "503-359-5481",
            "fax_number": "503-359-7882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2236 PACIFIC AVE",
            "address_2": "SUITE A",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162448",
            "telephone_number": "503-359-5481",
            "fax_number": "503-359-7882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAUGHN GRAY TIDWELL DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-23",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "VAUGHN",
        "authorized_official_middle_name": "GRAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-359-5481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, FICOI"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "5848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Grove, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.