| NPI | 1497845523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGGORY WAYNE SCOTT WILDE President 360-692-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE00004274) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |