| NPI | 1942820626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUILLERMO ENRIQUE CHACON President/Owner 253-445-0022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2020-04-22 |