| NPI | 1053857433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACEY WELIN Insurance Coordinator 503-617-7384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D6857) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-01-10 |