| NPI | 1164265633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL PETRISOR Surgeon 503-692-5654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2024-06-13 |