| NPI | 1366822017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEAU JEROME KELLER Dentist 425-409-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA 60555911) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2015-06-08 |