| NPI | 1184169252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK P SWENSEN Owner 541-753-8365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9063) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D6570) |
| 1223G0001X Dentist General Practice (Licence: OR D10522) | |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2016-12-28 |