| NPI | 1609443407 |
|---|---|
| Former Legal Business Name | EVERETT DENTAL PROFESSIONALS |
| Entity Type | Organization |
| Authorized Contact | JESSICA KNIGHT Credentialing Manager 360-659-8100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-06-09 |