| NPI | 1043369598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD D LACY President 503-692-0337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D4844) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |