| NPI | 1538867460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN LARSON Doctor 253-283-2747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-02-20 |