| NPI | 1013360502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK EARL GERMACK Owner 206-450-1939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WA DE00010298) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2022-07-21 |