| NPI | 1154743813 |
|---|---|
| Former Legal Business Name | STATEWIDE DENTURE SERVICES |
| Entity Type | Organization |
| Authorized Contact | JOSHUA DANIEL BROOKS Sole Member 509-586-4350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122400000X Denturist (Licence: WA DB00000391) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2020-08-24 |