| NPI | 1003295015 |
|---|---|
| Doing Business As | ELM STREET FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | LANE S HARRIS Member 541-928-2993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D7193) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D9733) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |