| NPI | 1023731551 |
|---|---|
| Doing Business As | LAKE BOONE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MATT J RICKE Manager 919-781-8610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2022-09-20 |