| NPI | 1124020920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED R. ANDERSON Owner/Operator 541-923-7633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D6510C) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-08-30 |