| NPI | 1770664385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS F TILSON Member 360-943-1910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE00007235) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2015-11-04 |