| NPI | 1699028290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR W. ALLEN President 360-834-5171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE 00007676) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-10-19 |