| NPI | 1821802000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERALD SCOTT PRUNER Owner/ President 206-215-2088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-02-06 |
| Last Update Date | 2025-02-06 |