| NPI | 1255544417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY M KELLER Office Coordinator 503-255-2424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR 380578) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2016-01-28 |