| NPI | 1235569070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA JUSTUS Owner 503-352-3800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2013-11-14 |