| NPI | 1932499035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT FREDERICK WAGNER Owner/President 503-239-5115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7549) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-06-08 |