| NPI | 1265505432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY WALLACE V.P. And CFO 206-987-2004 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA H-014) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: WA H-014) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2008-12-03 |