| NPI | 1083291405 |
|---|---|
| Doing Business As | MAIN STREET FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | JESSICA MILLER Practice Administrator 360-696-2513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2021-03-24 |