| NPI | 1093823510 |
|---|---|
| Doing Business As | DENTISTE |
| Entity Type | Organization |
| Authorized Contact | MICHELLE RENE MAYO Office Manager 425-284-0515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 9147) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 9147) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-08-22 |