| NPI | 1013077023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CHARLES YOUNG Owner President 509-453-4504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 6244) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |