| NPI | 1023409877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE KRISTEN BANCROFT Administrative Manager 5098-939-3635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA D5470) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2015-02-16 |