| NPI | 1902100316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE OLSON Bookkeeper 503-667-1431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D6660) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D7053) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9295) | |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2010-12-28 |