| NPI | 1609221449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHELSEA M NAGEL Credentialing Manager 360-357-4500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00010599) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2016-04-29 |