| NPI | 1770905879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELINA BUDREVICH Dental Hygienist 503-533-1755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR H5086) |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2014-01-09 |