| NPI | 1841283421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M GITELSON Doctor Owner 503-463-4663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: OR D7623) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2008-08-06 |