| NPI | 1538379417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD GRAHAM MCENTIRE Owner 360-456-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WA DE00007097) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |