| NPI | 1801309406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHELON TYLER RAMMELL Owner 253-278-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: TX 30871) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2021-09-15 |