| NPI | 1982965976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | W. DALE CRUM Owner 509-953-4067 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00007006) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |