| NPI | 1205536125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW LAWRENCE SLAVENSKI Chief Operating Officer 541-990-5088 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-03-08 |