| NPI | 1487864484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI SHACKELFORD Office Manager 425-485-0588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 7496) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 3400) |
| 1223G0001X Dentist, General Practice (Licence: WA 3134) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |