| NPI | 1356667026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WILLIAM BOTTORFF Owner 509-990-5821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: WA DE00009793) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2010-04-20 |