| NPI | 1255666467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE ROGER MILLGARD Dentist 509-526-9742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DH 00005586) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: OR H5723) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2009-10-05 |