| NPI | 1447589452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA COLE BOTHNE Business Administrator And Owner 503-644-7697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2009-12-22 |