| NPI | 1790239457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB J. RIDL Dentist 509-235-6241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60093486) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2016-08-11 |