| NPI | 1235422106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN N WILSON Dentist 509-536-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA 603-112-613) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2016-12-21 |