| NPI | 1548843766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JOHNSON Credentialing Specialist 509-315-8338 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2021-05-05 |