John Lindsay Tullis Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

OR5420 Issued in OR

Practice address

16463 Boones Ferry Rd Ste 200
The Olson Memorial Clinic
Lake Oswego, OR 97035-4375

Phone

(503) 635-7701

NPI assigned

Jun 25, 2008

Last updated

Jun 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214352000000",
    "number": "1871755587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16463 BOONES FERRY RD STE 200",
            "address_2": "THE OLSON MEMORIAL CLINIC",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354375",
            "telephone_number": "503-635-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16463 BOONES FERRY RD STE 200",
            "address_2": "THE OLSON MEMORIAL CLINIC",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354375",
            "telephone_number": "503-635-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLIS",
        "first_name": "JOHN",
        "middle_name": "LINDSAY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "OR5420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katyna Krysten Truval, ND, MPH
• Sharon Tsai, LPC, MSCP
• Yulia V Tsarenko-Carey, PCA
• TSL Well LLC
• Tonya Tucker Tafolla, RN
• Amy S Tung, RD
• Jeffrey Turner, M.D.
• Shelby Diane Tuthill, M.S.
• Ian Stuart Tydeman, DMD
• Issa Liley Ubidia-Luckett, MSW

• General Practice Dentistry in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.