| NPI | 1366811747 |
|---|---|
| Former Legal Business Name | LONE MOUNTAIN DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOSHUA DAVID ETMAN President/ Doctor 702-655-9533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NV 6547) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |