Provider Demographics
NPI:1700012010
Name:SPENDAL, DYLAN S (DMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:S
Last Name:SPENDAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 NE ELAM YOUNG PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6403
Mailing Address - Country:US
Mailing Address - Phone:971-371-3120
Mailing Address - Fax:971-371-3121
Practice Address - Street 1:5025 NE ELAM YOUNG PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6403
Practice Address - Country:US
Practice Address - Phone:971-371-3120
Practice Address - Fax:971-371-3121
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery