| NPI | 1144533142 |
|---|---|
| Doing Business As | AUTUMNWOOD DENTAL |
| Entity Type | Organization |
| Authorized Contact | BAKHTIAR ARDI PRIBADI Owner 360-474-9163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00010465) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2010-07-29 |