| NPI | 1417064312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN JOHN BERGMAN Owner 360-693-9349 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 8550) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 8362) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-08-22 |