| NPI | 1710433081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANCIE J WAGNER Dentist 509-242-3078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60294772) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |