| NPI | 1780956227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE BANKS Owner 360-698-3242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE00010823) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2014-01-16 |