| NPI | 1982156113 |
|---|---|
| Other Name | GRAND AVENUE DENTAL OFFICE |
| Entity Type | Organization |
| Authorized Contact | KENNETH R WRIGHT VP Dental Care Services 503-813-4660 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2021-06-01 |