| NPI | 1629285119 |
|---|---|
| Doing Business As | CLEAN SMILE |
| Entity Type | Organization |
| Authorized Contact | GAETANO ANTHONY AMICO President 503-363-8885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D4703) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-08-22 |