| NPI | 1184694317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN MUCKERHEIDE Owner 503-641-8800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D8526) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2020-08-22 |