| NPI | 1689348583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DIVIS Owner 509-664-2920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2021-08-04 |