| NPI | 1104067198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES CROASDILL WATSON CROASDILL Owner 253-759-5414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA 5005) |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2009-03-20 |