| NPI | 1649677477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON WILSON Office Manager 503-581-2446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D8053) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2015-01-06 |