Provider Demographics
NPI:1619556628
Name:TYLOR BREKKE DMD MS PC
Entity Type:Organization
Organization Name:TYLOR BREKKE DMD MS PC
Other - Org Name:BREKKE & SAYRE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLOR
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BREKKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:503-648-7775
Mailing Address - Street 1:536 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4118
Mailing Address - Country:US
Mailing Address - Phone:503-648-7775
Mailing Address - Fax:
Practice Address - Street 1:536 SE OAK ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4118
Practice Address - Country:US
Practice Address - Phone:503-648-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty