| NPI | 1831686468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEV A CLARK Doctor 503-371-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D10561) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-04-19 |