Provider Demographics
NPI:1548271364
Name:TOWN CENTER DENTAL CARE INC
Entity type:Organization
Organization Name:TOWN CENTER DENTAL CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRYON
Authorized Official - Last Name:LORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-682-9191
Mailing Address - Street 1:8263 SW WILSONVILLE RD
Mailing Address - Street 2:STE C
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:503-682-9191
Mailing Address - Fax:503-682-9459
Practice Address - Street 1:8263 SW WILSONVILLE RD
Practice Address - Street 2:STE C
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-682-9191
Practice Address - Fax:503-682-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD71791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty