| NPI | 1023729969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIE ROSE MORRELL DIEPENHEIM Owner/Member 541-262-6101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2025-11-20 |