| NPI | 1295080836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK W. CONKLIN Dentist/Owner/ President 503-762-2525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D8325) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-07-19 |