| NPI | 1831624402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND PARK Governor 425-284-9886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60467195) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2017-04-20 |