| NPI | 1538056783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAITLYN HANSEN Revenue Assurance Specialist 360-710-1851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2025-06-20 |
| Last Update Date | 2025-06-20 |