| NPI | 1316021520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLI CLEMENS Financial Coordinator 253-939-2552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 4033) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |