| NPI | 1043592397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH R HENDRICKSON Office Manager 360-426-9711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 4275) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2011-09-13 |