| NPI | 1558636894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA KAY BLAUWIEKEL Office Manager 503-656-1905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR 6499) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2012-03-20 |