| NPI | 1104249465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN GREGORY RUSSELL Doctor/Owner 360-377-7621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE00009670) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-22 |