Provider Demographics
NPI:1740429026
Name:TYBERG, ADAM PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PAUL
Last Name:TYBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21000 SW DAHLKE LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8386
Mailing Address - Country:US
Mailing Address - Phone:503-925-8600
Mailing Address - Fax:
Practice Address - Street 1:21000 SW DAHLKE LN
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8386
Practice Address - Country:US
Practice Address - Phone:503-925-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD92581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice