| NPI | 1902032063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A JOHNSON President 360-254-1590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA 6095) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2009-06-03 |