| NPI | 1104908433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIELA ANN GIBSON Office Manager 541-344-6371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7890) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-08-22 |