| NPI | 1114173077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA A BLOCK President 253-858-8581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 6692) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 6846) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2008-08-12 |