| NPI | 1639103658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN A KOONING President 503-289-9621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D6081) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-08-22 |