Healthcare Provider Details

I. General information

NPI: 1023184801
Provider Name (Legal Business Name): SAMY F TANYOS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12710 SE DIVISION ST
PORTLAND OR
97236-3134
US

IV. Provider business mailing address

14751 SW BEARD RD UNIT 104
BEAVERTON OR
97007-8138
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-3816
  • Fax: 503-988-5903
Mailing address:
  • Phone: 503-524-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6650
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: