| NPI | 1760752141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH BERG Owner 541-779-4517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D4310) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D4738) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-01-03 |