| NPI | 1285007807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYNNA RUST Dental Hygienist 541-571-7605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR H6967) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2015-11-04 |