| NPI | 1215482757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA A ELLINGSEN Sec/Treasurer 509-467-2606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WA DE00006353) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2016-08-24 |