| NPI | 1932203502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE KENNETH TRAVIS Dentist / Owner 425-483-5959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00005037) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00005037) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2012-06-01 |