| NPI | 1356815518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY CHARRON Owner 541-619-6218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 126800000X Dental Assistant | |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2019-01-21 |