| NPI | 1619320900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP NORMAN HODGE Owner/General Dentist 253-852-4746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE 00004936) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2016-07-21 |