| Organization Name: | TILLAMOOK DENTURE CLINIC |
| NPI Number: | 1154747426 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARGARETA HANIKYROVA-BORLAND (OWNER-DENTURIST) |
| Mailing Address: | 2505 Main Ave N Tillamook |
| State: | OR US |
| Postal Code: | 971419225 |
| Phone Number: | 5033542050 |
| Fax Number: | |
| NPI Enumeration Date: | 03/11/2014 |
| NPI Last Update Date: | 03/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DT-DO-10125318 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |