| NPI | 1366755613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER JAMES PETERSON Employer 503-760-8409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 292200000X Dental Laboratory (Licence: OR DTDO949472) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2010-07-15 |