| NPI | 1114261187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL R JORGENSON Owner 360-733-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00010175) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |