| NPI | 1275098279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSY LEE HAGGARD Office Manager 360-779-7711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223X2210X Dentist Orofacial Pain |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2022-11-02 |