| NPI | 1407275605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN DELISLE Owner 425-306-2579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 5929) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6069) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-04-15 |