| NPI | 1023483534 |
|---|---|
| Doing Business As | GENTLE DENTAL SPARKS |
| Entity Type | Organization |
| Authorized Contact | BRADLEY R PETERSON Pc Owner/President 360-869-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2025-08-22 |