| NPI | 1013439843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHADD J COCKRELL Owner Dentist 360-349-2401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ME DEN4570) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-07-21 |