| NPI | 1417407859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY RICHARDSON Owner/Manager 360-852-0809 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: OR D9577) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |