| NPI | 1700819596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA LYNN SOWLES Office Manager 541-773-3422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7789) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR 5563) |
| 1223G0001X Dentist, General Practice (Licence: OR 6025) | |
| 1223G0001X Dentist, General Practice (Licence: OR D6735) | |
| 1223G0001X Dentist, General Practice (Licence: OR D6571) | |
| 1223G0001X Dentist, General Practice (Licence: OR D8765) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-08-22 |