| NPI | 1578724407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAUGHN GRAY TIDWELL Owner 503-359-5481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR 5848) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2008-06-23 |