| NPI | 1164089934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN COLLETTE Owner 509-366-6882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |