| NPI | 1912356411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS ANDREW RAKLIOS Owner 541-508-5946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE 60557938) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2023-12-13 |