| NPI | 1225759111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN LARSON Doctor/Owner 253-283-2747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-09-08 |