| NPI | 1063774784 |
|---|---|
| Other Name | EASTSIDE PERIODONTICS & IMPLANTOLOGY |
| Entity Type | Organization |
| Authorized Contact | LAURISSA M CHAMPION Owner 503-954-1372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D8555) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2012-06-08 |