| NPI | 1003099466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK RICHARD DAMON Owner 360-676-6060 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE7966) |
| Enumeration Date | 2007-12-08 |
| Last Update Date | 2019-05-23 |