| NPI | 1679023493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER KREIDLER-MOSS CEO 360-478-2366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 126800000X Dental Assistant | |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2017-01-31 |