| NPI | 1831320993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER CARL WAGNER President 360-748-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2009-08-06 |