| NPI | 1093433815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YADIRA GONZALEZ Credentialing 509-946-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-08-17 |