| NPI | 1861040800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANETTE MCINTOSH Regional Operations Manager 425-396-1011 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-12-30 |