| NPI | 1366541328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN C LO Owner 253-584-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE7800) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE7799) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |