| NPI | 1174646129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS K MCCLAIN Front Office Coordinator 503-645-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D8051) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-08-22 |