| NPI | 1053661777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADY CLARKE MCDONALD Owner 360-352-4008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 10554) |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2012-09-11 |