| NPI | 1063787166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CHARLES ROYSE Owner 503-223-3910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OR D6613) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |