NPI | 1467778639 |
---|---|
Entity Type | Organization |
Authorized Contact | CHANTE RENEE JOHNSON Receptionist 253-373-0000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 7648) |
Additional Taxonomies | 122300000X Dentist (Licence: WA 7648) |
Enumeration Date | 2010-04-13 |
Last Update Date | 2010-04-13 |