| NPI | 1104061969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES F EBSWORTH President 206-362-0152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00004073) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2008-12-09 |