| NPI | 1154517415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY T PEDERSON Oral Surgeon 503-581-0223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D4658) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2007-09-20 |