| NPI | 1376647743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE D RICHARDSON Treatment Coordinator 360-876-0550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 9302) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 7181) |
| 122300000X Dentist (Licence: WA DE00009872) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2020-08-22 |