| NPI | 1518646454 |
|---|---|
| Doing Business As | BROOKSIDE DENTAL-CLACKAMAS |
| Entity Type | Organization |
| Authorized Contact | DEBBIE LOPEZ Regional Manager 503-914-8221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2023-07-17 |