| NPI | 1407109937 |
|---|---|
| Doing Business As | PROVIDENCE ORAL HEAD AND NECK CLINIC |
| Entity Type | Organization |
| Authorized Contact | KEENAN FREEMAN CFO 503-893-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2012-10-22 |