| NPI | 1104059013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN ASHMORE Member 360-479-2323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA 8684) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2009-08-25 |