| NPI | 1801022934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DOUGLAS JOHNSON Dentist 253-565-1695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00005841) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60096175) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2009-06-03 |