| NPI | 1215390091 |
|---|---|
| Doing Business As | WALLACE |
| Entity Type | Organization |
| Authorized Contact | STUART CURRIE Cmo 503-489-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 122300000X Dentist |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-02-24 |