| NPI | 1750526893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANA JEANINE BALLARD Office Manager 503-588-6960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR 5026) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR 5206) |
| 122300000X Dentist (Licence: OR 5090) | |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2008-12-03 |