| NPI | 1558792051 |
|---|---|
| Doing Business As | JANTZEN BEACH MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | TODD R COCKRELL Owner 503-241-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2013-12-09 |