| NPI | 1356530422 |
|---|---|
| Doing Business As | DENTAL PROFESSIONAL |
| Entity Type | Organization |
| Authorized Contact | KEN W WADDELL Owner 503-684-8445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D5796) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-15 |