Healthcare Provider Details

I. General information

NPI: 1700012010
Provider Name (Legal Business Name): DYLAN S SPENDAL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 NE ELAM YOUNG PKWY SUITE 100
HILLSBORO OR
97124-6403
US

IV. Provider business mailing address

5025 NE ELAM YOUNG PKWY SUITE 100
HILLSBORO OR
97124-6403
US

V. Phone/Fax

Practice location:
  • Phone: 971-371-3120
  • Fax: 971-371-3121
Mailing address:
  • Phone: 971-371-3120
  • Fax: 971-371-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD9351
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: