| NPI | 1346393444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE R FISHER H.R. 360-943-4205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 6203) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 7112) |
| 1223G0001X Dentist, General Practice (Licence: WA 6001675) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2009-02-04 |