| NPI | 1063573699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD JON SUNDBERG President 509-529-3762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE00004263) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2008-09-25 |