| NPI | 1093926156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELA HALLER NESS Dentist 360-568-5411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00006298) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |