| NPI | 1265815799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW DALE GORDON Buisness Manager 541-269-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9619) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9399) |
| 1223G0001X Dentist, General Practice (Licence: OR D9604) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2015-07-01 |