Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | D6314 | OR |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD13968 | OR |
NPI | 1194896548 |
---|---|
Provider Name | Dr. David Ross Tenhulzen |
First Address | Tualatin, OR 97062 |
Second Address | Tualatin, OR 97062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |