| NPI | 1447369350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA A ELLINGSEN Member 509-921-5666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE00009902) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE00006464) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |