NPIMap

Individual provider Active NPI

Ian Stuart Tydeman, DMD

  • General Practice Dentistry
  • Lake Oswego, OR
National Provider Identifier
1689830556
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9162 Issued in OR
Practice address
14800 Kruse Oaks Blvd
Suite a
Lake Oswego, OR 97035-8603
Phone
(503) 684-2944
NPI assigned
Jul 31, 2008
Last updated
Jul 31, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D9162 OR Primary

Addresses

Primary practice location

14800 Kruse Oaks Blvd
Suite a
Lake Oswego, OR 97035-8603

Mailing address

14800 Kruse Oaks Blvd
Suite a
Lake Oswego, OR 97035-8603
Phone (503) 684-2944

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D9162ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Mayerle & Tydeman, LLC Past Accepting new patients
Mayerle Dental General Practice Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217462400000",
    "number": "1689830556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14800 KRUSE OAKS BLVD",
            "address_2": "SUITE A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358603",
            "telephone_number": "503-684-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 KRUSE OAKS BLVD",
            "address_2": "SUITE A",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970358603",
            "telephone_number": "503-684-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYDEMAN",
        "first_name": "IAN",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2008-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9162",
            "primary": true
        }
    ],
    "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 Jul 31, 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.