| NPI | 1609878172 |
|---|---|
| Professional Name | WILLAMETTE VALLEY ORAL & MAXILLOFACIAL SURGERY, INC |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D6585) |
| Enumeration Date | 2005-08-13 |
| Last Update Date | 2007-07-08 |