| NPI | 1225458441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JACOB RAPHAEL Co Owner 503-893-2889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OR D9732) |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2014-04-27 |