| NPI | 1982761235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN ARDELL MOE Practice Management Administrator 206-263-8807 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2022-10-13 |