| NPI | 1679854350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS WILSON Member 360-420-5209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA 603085070) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2013-01-31 |