| NPI | 1982628939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY IRENE FETTIG President 360-892-7107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122400000X Denturist (Licence: WA DN0000195) |
| Additional Taxonomies | 122400000X Denturist (Licence: WA DN00000393) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-08-22 |