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General NPI Number Information
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NPI Number | 1780234575
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Entity Type | Organization
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Legal Business Name | THOMAS D. CARDWELL, DMD, PC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 11400 SE 37TH AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-5982
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Country | US
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Telephone | 503-774-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 SW ELM ST APT 4
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City | PORTLAND
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State | OR
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Zip | 97201-7602
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Country | US
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Telephone | 503-913-6193
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS CARDWELL
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Credential | DMD
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Telephone | 503-913-6193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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