NPI | 1104173244 |
---|---|
Entity Type | Organization |
Authorized Contact | IAN STUART TYDEMAN Dentist 503-577-3168 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OR D6896) |
Additional Taxonomies | 122300000X Dentist (Licence: OR D9162) |
Enumeration Date | 2012-08-08 |
Last Update Date | 2012-08-08 |