| NPI | 1679621080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRENCE A CLARK Owner 503-682-0431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D6352) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7370) |
| 1223G0001X Dentist, General Practice (Licence: OR D7842) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-08-22 |