| NPI | 1376718957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY R JOHNSON President/Owner 360-895-8841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00008961) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |