Healthcare Provider Details

I. General information

NPI: 1578290003
Provider Name (Legal Business Name): STEPHEN LEONARD TISCHLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PACIFIC BLVD SE STE 201
ALBANY OR
97321-7904
US

IV. Provider business mailing address

9478 SE DUNDEE DR
HAPPY VALLEY OR
97086-7071
US

V. Phone/Fax

Practice location:
  • Phone: 855-433-6825
  • Fax:
Mailing address:
  • Phone: 503-943-9277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number380713
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: