| NPI | 1063942043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH E KRUEGER Owner 541-617-3993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D6629) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2023-01-10 |