| NPI | 1508316910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN R. OTTOSEN Owner 509-664-6669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA 604-034-843) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |