| NPI | 1265793129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR CARNELL Dentist 509-326-8120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE00002797) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00002797) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |