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 |