| NPI | 1083169668 |
|---|---|
| Doing Business As | SMILE SOURCE SPOKANE |
| Entity Type | Organization |
| Authorized Contact | ERIC C ELLINGSEN Owner 509-924-2866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA 601992748) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2016-08-24 |