| NPI | 1396021895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA STEPHENS Owner 253-520-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00010031) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2011-10-27 |