| NPI | 1538614680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC T WAGAR Dentist 425-226-1244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60284727) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |