| NPI | 1942710231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE KRISTEN BANCROFT Admin Manager 509-242-3336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2019-04-04 |