| NPI | 1487702601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLEE ANN ELIZABETH SANKEY Credentialing Supervisor 206-474-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WA 6005372781) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2019-01-29 |