| NPI | 1336797273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL WOODLAND Credentialing Specialist 253-681-6601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 122300000X Dentist | |
| 1223D0001X Dentist, Dental Public Health | |
| 1223E0200X Dentist, Endodontics | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |