| NPI | 1821410663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL M HENRICKSEN Dentist/Owner 360-748-4481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WA 5334800) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2015-04-29 |