| NPI | 1649642638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CHRISTOPHER PAXTON Owner 509-242-3336 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2016-01-25 |