| NPI | 1891934550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE HOUSTON HACKNEY Partner/Dentist 360-426-1676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE60035243) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2009-02-19 |