| NPI | 1215255518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN GILLESPIE Sole Member 360-892-6132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 00005353) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2015-02-13 |