| NPI | 1689080467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL KENNETH JOHNSON Owner 425-277-1844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center Oral and Maxillofacial Surgery (Licence: WA DE00006475) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2014-07-01 |