| NPI | 1497922041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL ERICKSON Dentist/Owner 503-353-1471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: OR D6120) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |