| NPI | 1366536534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR D IMMEL Direct Owner 509-457-5387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 6921) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |