| NPI | 1043394828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED D. EVANS President 509-252-4746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00006525) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE00010191) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |