| NPI | 1427502095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LOUIS OSTENSON Owner 360-693-3112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00004387) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: WA DE60167618) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2016-08-11 |