| NPI | 1619423787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GARRITY Administrator 541-617-3993 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D6629) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2023-01-20 |