| NPI | 1558752352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK JULIAN WORRELL Member 206-294-9001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE60238959) |
| Enumeration Date | 2015-02-15 |
| Last Update Date | 2015-02-15 |