| NPI | 1144611211 |
|---|---|
| Doing Business As | EAST LAKE VILLAGE DENTAL |
| Entity Type | Organization |
| Authorized Contact | VELIA FUENTES Office Manager 714-695-9530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 44744) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |