| NPI | 1215373931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNARD JOHN LARSON President 360-428-3565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA 7195) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2013-05-21 |