| 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 |