| NPI | 1063806693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW P SHOLUDKO Dentist/Owner 774-278-0412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WA DE60484387) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |