| NPI | 1275862468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEE R THYSELL Temp Ofc Mgr 509-577-8279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 7703) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2009-12-17 |