| NPI | 1689090110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH JOHNSON Doctor 509-663-0060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: WA DE60337452) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: WA MD60336798) |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: OR D9077) | |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2014-03-07 |