| NPI | 1740560911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DOUGLAS TEIGEN Owner 360-425-8140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE7669) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2011-08-19 |