IndividualActive
Tyler Bradstreet
NPI 1699126532 · General Practice Dentistry · Gresham, OR
Provider details
- NPI number
- 1699126532
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Sex
- Male
- Sole proprietor
- No
- License
- D10466 (OR)
Specialties & taxonomies
Dental Providers
Practice location
23479 Se Stark St
Ste. 102
Gresham, OR 97030-2962
Phone: (503) 667-1184
Approximate (ZIP-level) locationGet directions
Mailing address
14740 Nw Cornell Rd Ste 120
Portland, OR 97229-5400
Registry dates
- Enumerated
- 2016-06-22
- Last updated
- 2021-01-13
- Certified
- 2021-01-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.