| NPI | 1609459346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH L HANCOCK Dentist/Owner 360-753-7388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122400000X Denturist |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2021-04-30 |