| NPI | 1013098094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL W LARY Administrator 503-861-6244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 207QA0505X Family Medicine, Adult Medicine | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |