| NPI | 1669759767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE JEAN CRANE Office Manager 503-231-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OR 5651) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: OR 9096) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2013-07-11 |