| NPI | 1104490390 |
|---|---|
| Doing Business As | FRESH DENTAL |
| Entity Type | Organization |
| Authorized Contact | HUNG LUONG Owner/Dentist 267-357-7119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2021-05-13 |