| NPI | 1043556111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTY NEEDHAM CEO 509-547-2204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 1223G0001X Dentist, General Practice | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2024-01-11 |