| NPI | 1275460560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE FOWLER Office Manager 206-641-7212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2026-05-08 |
| Last Update Date | 2026-05-08 |