Provider Demographics
NPI:1174657217
Name:DIMITRIOS J. VARELDZIS DDS, PC
Entity Type:Organization
Organization Name:DIMITRIOS J. VARELDZIS DDS, PC
Other - Org Name:BULL MOUNTAIN FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRIOS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VARELDZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-639-5025
Mailing Address - Street 1:15885 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2647
Mailing Address - Country:US
Mailing Address - Phone:503-639-5025
Mailing Address - Fax:503-684-1391
Practice Address - Street 1:15885 SW 116TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-2647
Practice Address - Country:US
Practice Address - Phone:503-639-5025
Practice Address - Fax:503-684-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty