| NPI | 1114261104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LEE KECK-ERICKSON Dentist 541-779-2634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9139) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D9158) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-19 |