| NPI | 1699079442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY J ALEXANDER Office Manager 360-676-9050 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00005114) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00010402) |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2011-01-07 |