Basic Information
Provider Information
NPI: 1760935563
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAIRA
FirstName: LINDSAY
MiddleName: K
NamePrefix: DR.
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6950 NE CAMPUS WAY
Address2:  
City: HILLSBORO
State: OR
PostalCode: 971245611
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 7095 SW GONZAGA ST
Address2:  
City: TIGARD
State: OR
PostalCode: 972238309
CountryCode: US
TelephoneNumber: 8554336825
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/27/2016
LastUpdateDate: 08/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDT-2661HIN Dental ProvidersDentist 
122300000XD10490ORY Dental ProvidersDentist 

No ID Information.


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