| NPI | 1639604689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN T ALLRED Owner 503-858-4880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OR D9387) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-04-27 |