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1104209386
FELIX WIYANTO SIM
PORTLAND, OR
NPI
1104209386
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
204E00000X Oral & Maxillofacial Surgery
(Licence: OR FE172458)
Enumeration Date
2015-07-07
Last Update Date
2015-07-07
Business Address
-- FELIX WIYANTO SIM MBBS, BDS
1015 NW 22ND AVE
PORTLAND, OR 97210-3025
Phone number: 503-413-4656
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Mailing Address
-- FELIX WIYANTO SIM MBBS, BDS
5710 SW GROVER CT
PORTLAND, OR 97221-1304
Phone number: 503-915-2879
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