| NPI | 1689847683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC C ELLINGSEN Owner 509-924-2866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE79703) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2008-06-19 |