Provider Demographics
NPI:1851654537
Name:TIGARD TRIANGLE SMILES, PC
Entity Type:Organization
Organization Name:TIGARD TRIANGLE SMILES, PC
Other - Org Name:TIGARD TRIANGLE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-620-2319
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:7275 SW DARTMOUTH ST
Practice Address - Street 2:SUITE 180
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8623
Practice Address - Country:US
Practice Address - Phone:503-620-2319
Practice Address - Fax:503-620-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty