| NPI | 1962506113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE T LORENZEN Office Manager 503-246-8447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR 6344) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR 6336) |
| Enumeration Date | 2006-09-09 |
| Last Update Date | 2010-07-22 |