| NPI | 1043591043 |
|---|---|
| Doing Business As | YELM PRAIRIE DENTAL |
| Entity Type | Organization |
| Authorized Contact | JAMES VINCENT SHUCK VP 360-458-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00006408) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-25 |