| NPI | 1205220209 |
|---|---|
| Doing Business As | GRANT PARK DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | TODD R COCKRELL Owner 503-282-0521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2015-03-27 |