| NPI | 1932613684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL TETRICK Dentist/Owner 360-734-4374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2023-03-24 |