| NPI | 1699070466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY SHILLING Office Manager 509-535-7791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00005661) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2011-01-25 |