| NPI | 1497980551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY WAITE Office Manager 360-675-7573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 00010051) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2009-05-19 |