| NPI | 1912124637 |
|---|---|
| Other Name | TIETAN DENTAL TEAM |
| Entity Type | Organization |
| Authorized Contact | DON R KELLOGG Secretary 509-522-0940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00004225) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2013-05-31 |