| NPI | 1043586019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA E. MADDEN Owner 360-459-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA 00009862) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2013-04-12 |