| NPI | 1811121932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP PATRICK GREEN Owner 503-646-7101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2009-05-04 |