| NPI | 1689694291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH A SLACK Office Manager 541-754-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D54041) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D6074) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |