| NPI | 1790977965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN M SWAN Program Manager 509-865-5121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: PA DS-091445-L) |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2009-07-09 |