| NPI | 1346478906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY H DIEHL President 360-693-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE60083669) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2014-05-28 |