| NPI | 1902090210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LENORE SM INGRAM President 360-754-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA 5076) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |