| NPI | 1215535695 |
|---|---|
| Doing Business As | SMILE SOURCE SPOKANE |
| Entity Type | Organization |
| Authorized Contact | ERIC C ELLINGSEN Owner 509-924-2866 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2020-10-16 |
| Last Update Date | 2020-10-21 |