Provider Demographics
NPI:1770067084
Name:TODD A GIFFORD DMD PC
Entity type:Organization
Organization Name:TODD A GIFFORD DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-432-1600
Mailing Address - Street 1:1616 SW SUNSET BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2641
Mailing Address - Country:US
Mailing Address - Phone:503-246-1710
Mailing Address - Fax:
Practice Address - Street 1:1616 SW SUNSET BLVD STE E
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2641
Practice Address - Country:US
Practice Address - Phone:503-246-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty