| NPI | 1851744478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN WAGNER Owner/ Orthodontist 425-483-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 602680925) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |