| NPI | 1487183000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH C MULREAN Co Owner 360-456-5678 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA 601803289) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-07-21 |