| NPI | 1639408594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY CLARK LINGENBRINK Owner/President 360-697-3008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE00010454) |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2009-12-23 |