| NPI | 1629194964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER C. WAGNER President 360-748-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 6937) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |