| NPI | 1700029709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN M. BAHAM Office Manager 541-928-2301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7915) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8673) |
| 1223G0001X Dentist, General Practice (Licence: OR D9084) | |
| 1223G0001X Dentist, General Practice (Licence: OR D9107) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2009-04-07 |