| NPI | 1750734620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DRUE CHARLES PICKENS Owner/Dentist 360-254-6411 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE60502335) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2016-07-15 |