| NPI | 1629501374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN ROBINSON Office Manager 360-786-9354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA FE0360406) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60651940) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |