| NPI | 1194143065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANIMONE PHANTHAMATH Dental Hygienist 503-715-7876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: OR H5456) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |