| NPI | 1376738062 |
|---|---|
| Doing Business As | EASTLAKE PERIODONTICS AND IMPLANTS |
| Entity Type | Organization |
| Authorized Contact | SCOTT TADASHI OZAKI Owner 619-482-3205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CA 41977) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2007-09-06 |