| NPI | 1841079415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VISHAL P PANCHMATIA Owner 503-270-7319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2023-10-07 |