| NPI | 1114775640 |
|---|---|
| Doing Business As | STATE STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | JASON CHAMPAGNE Owner 775-359-3934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-05-09 |