| NPI | 1316164056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVA J. WILSON Office Manager 503-925-1566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D7723) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2012-01-24 |