| NPI | 1588117568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE DONALDSON NELSON Owner/Dentist 360-696-9461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00006928) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2016-07-26 |