| NPI | 1568850279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROCK D HERRIGES Periodontist 503-252-5515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D8371) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |