Provider Demographics
NPI:1114553468
Name:ANDREW SYPE DMD, PC
Entity Type:Organization
Organization Name:ANDREW SYPE DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SYPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-544-7091
Mailing Address - Street 1:12758 SE STARK ST STE D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1539
Mailing Address - Country:US
Mailing Address - Phone:503-760-3214
Mailing Address - Fax:
Practice Address - Street 1:12758 SE STARK ST STE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1539
Practice Address - Country:US
Practice Address - Phone:503-760-3214
Practice Address - Fax:503-719-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental