| NPI | 1144416959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS HICKS President 503-644-5433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7362) |
| Enumeration Date | 2007-09-15 |
| Last Update Date | 2007-09-15 |