| NPI | 1700165362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN R GRIFFIN Administrator 541-929-5227 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7915) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9107) |
| 1223G0001X Dentist, General Practice (Licence: OR D9084) | |
| 1223G0001X Dentist, General Practice (Licence: OR D9451) | |
| 1223G0001X Dentist, General Practice (Licence: OR D9586) | |
| 1223G0001X Dentist, General Practice (Licence: OR D9614) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-08-12 |