| NPI | 1114045366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK RICHARD DAMON President 360-676-6060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA DE 7966) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2012-08-06 |