| NPI | 1750635397 |
|---|---|
| Doing Business As | MADISON WELLNESS CENTER DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARK SECORD Provider Enrollment Specialist 206-548-3114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2012-11-05 |