| NPI | 1528757432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK IM Owner 360-779-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2023-05-10 |