Provider Demographics
NPI:1578985495
Name:TJIPTOWIDJOJO, FRANSISKUS ANDRIANTO (DDS, MS)
Entity Type:Individual
Prefix:
First Name:FRANSISKUS ANDRIANTO
Middle Name:
Last Name:TJIPTOWIDJOJO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 SE 91ST AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3762
Mailing Address - Country:US
Mailing Address - Phone:503-653-2299
Mailing Address - Fax:503-774-4154
Practice Address - Street 1:9300 SE 91ST AVE STE 403
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3762
Practice Address - Country:US
Practice Address - Phone:503-653-2299
Practice Address - Fax:503-774-4154
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010217101223P0700X
VA04014142341223P0700X
IL019.0325071223P0700X
ORD115651223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty