| NPI | 1700192184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH NICHOL Office Manager 503-254-0897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OR D8506) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: OR D9389) |
| 261QD0000X Clinic/Center, Dental (Licence: OR D8961) | |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-08-24 |