| NPI | 1154673846 |
|---|---|
| Doing Business As | SOUTH LAKE PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | YAIMARA DIAZ Office Manager 704-875-9075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 7221) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2012-10-05 |