| NPI | 1962956847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY JORGENSEN Bookkeeper 509-765-7853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00008463) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2016-08-09 |