| NPI | 1720431414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID OLSON Dentist 206-623-7591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA DE60160199790) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |