Provider Demographics
NPI:1891983359
Name:GIFFORD, TODD A (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:GIFFORD
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 1:1616 SW SUNSET BLVD.,
Mailing Address - Street 2:STE. E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-246-1710
Mailing Address - Fax:866-339-7503
Practice Address - Street 1:1616 SW SUNSET BLVD.,
Practice Address - Street 2:SUITE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-246-1710
Practice Address - Fax:866-339-7503
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD90241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice