Healthcare Provider Details

I. General information

NPI: 1174657217
Provider Name (Legal Business Name): DIMITRIOS J. VARELDZIS DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15885 SW 116TH AVE
TIGARD OR
97224-2647
US

IV. Provider business mailing address

15885 SW 116TH AVE
TIGARD OR
97224-2647
US

V. Phone/Fax

Practice location:
  • Phone: 503-639-5025
  • Fax: 503-684-1391
Mailing address:
  • Phone: 503-639-5025
  • Fax: 503-684-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6471
License Number StateOR

VIII. Authorized Official

Name: DR. DIMITRIOS JOHN VARELDZIS
Title or Position: PRESIDENT
Credential: DDS
Phone: 503-639-5025