| NPI | 1568912434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BHARATHI CHARUGUNDLA Owner 360-369-6420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WA DE60656547) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |