| NPI | 1255761524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY REED Dental Hygienist 503-352-4896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR H5039) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2013-11-22 |