| NPI | 1285410324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA A GUREVICH KUSHNER Owner 360-779-7711 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2023-11-08 |