| NPI | 1801902101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNSEY B WICKWIRE Practice Manager 541-345-4076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR 5897) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-08-22 |