| NPI | 1205041514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUNIB Y. DERHALLI President 360-254-8151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE7432) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |