| NPI | 1366732141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER H HERTZ Owner 360-830-6637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD 00035886) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2011-04-13 |