| NPI | 1255889333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI COMER Dental Program Director 971-205-7475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OR H7259) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2016-09-16 |