| NPI | 1780056341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY PLASTER President 509-747-2070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 9667) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 9903) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |