| NPI | 1235887555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SHANLEY Controller 425-226-1990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-03-15 |