| NPI | 1609523166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLIE WASSERMAN Dentist 541-797-9136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2024-04-02 |