| NPI | 1023766565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE FOWLER Office Coordinator 360-391-7872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2022-03-14 |