| NPI | 1255694147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE M HENNESSEY Owner 425-774-7781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00010589) |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2012-06-17 |