| NPI | 1659592103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDRICK W WICKNICK President 360-671-4859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00006347) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-11-19 |