Facts
- Status
- A
- Credential
- DMD
- Type
- Individual
- Enumeration date
- 2023-07-06
- Last updated
- 2026-04-29
Specialties
Licenses
- License OR
- D11841
Location
- Practice location
- 25647 REDWOOD HWY
- City
- CAVE JUNCTION OR
- Postal code
- 975239332
- Phone
- 541-592-4111
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.