| NPI | 1316280753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON SPALDING Member 509-680-4396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AK 1353) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: AK 1316) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2013-04-04 |