| NPI | 1679728711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONWAY JENSEN Owner 360-666-0530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE00010670) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2022-02-22 |