| NPI | 1992182026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMILLE STARK Cpcs Credentialing Specialist 503-952-2125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D8124) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2015-04-27 |