Provider Demographics
NPI:1184928384
Name:KAADY, TYLER (RDH)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:KAADY
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 SW PLEASANT VIEW DR APT 304
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5787
Mailing Address - Country:US
Mailing Address - Phone:503-412-8999
Mailing Address - Fax:
Practice Address - Street 1:1324 SW PLEASANT VIEW DR APT 304
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-5787
Practice Address - Country:US
Practice Address - Phone:503-412-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5821124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR526821OtherMARSH