| NPI | 1881809945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES FULLMER SELANDER Doctor Owner 360-457-3669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00008354) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |