| NPI | 1194125351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MATTHEW GALLUCCI President 503-657-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9304) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2014-09-30 |