| NPI | 1639448459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN DAWN LABOUNTY Manager 425-869-7560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE0006423) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |