| NPI | 1487228961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK THOMPSON Owner 509-823-4480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| 122400000X Denturist | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-05-18 |