| NPI | 1093671620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH Y DE JESUS President 360-943-4531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2025-12-29 |
| Last Update Date | 2025-12-29 |