| NPI | 1194854398 |
|---|---|
| Doing Business As | LINCOLN AVENUE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | SHANNON FERNANDEZ Billing VP 509-865-6175 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2022-11-01 |