| NPI | 1962733600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN CAIN President 480-471-9560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WA DN60082396) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: WA DN60082396) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2010-01-20 |