| NPI | 1124106687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L GEORGE Owner 360-568-1519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE00010038) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-11-02 |