| NPI | 1043624505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN EDWARDS Organizer 509-434-9364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 041413260) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2014-06-12 |