| NPI | 1043774854 |
|---|---|
| Doing Business As | EASTLAKE MODERN DENTISTRY DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | EMILIANO NAVEJAS CARPIO Dds/Owner 619-348-5324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2022-02-04 |