| NPI | 1154876043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY BANICH Owner/Dentist 509-684-4586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60097161) |
| Enumeration Date | 2016-08-20 |
| Last Update Date | 2016-08-20 |