| NPI | 1124234042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELSA BURK Business Manager 509-326-8170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 4850) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 8323) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-22 |