| NPI | 1972014983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY CARL PAVENTY Owner 509-475-5367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-4386) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2017-10-17 |