| NPI | 1710109210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARL DAVID ROSE Dentist 360-687-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 7107) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 9791) |
| 122300000X Dentist (Licence: WA 4539) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2008-06-18 |