| NPI | 1235790510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HILLARY ANNE BERRY Manager 425-409-1655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2022-10-03 |