| NPI | 1730856774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN TODD WALTER Owner 503-857-7026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-10-08 |