| NPI | 1194079343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID TIMOTHY GARLOCK President 503-317-4837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO DEN00201873) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2012-11-08 |