| NPI | 1013122076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY L HANSON President 360-779-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE6404) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2013-06-14 |