| NPI | 1407476484 |
|---|---|
| Doing Business As | EASTSIDE MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SOFIA SEGURA Credentialing Manager 509-901-2239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2020-04-20 |