| NPI | 1952963704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JA-ANGEL DEWALT Revenue Cycle Manager 360-475-6711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2020-04-28 |