| NPI | 1750767661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BOLDT Part Owner 541-772-2756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D6349) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2015-08-03 |