| NPI | 1649573585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | R. MIKE SHIRTCLIFF Authorized Representative 541-447-5838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |