NPI | 1437523776 |
---|---|
Doing Business As | INNOVATIVE DENTISTRY AT SOUTH LAKE UNION |
Entity Type | Organization |
Authorized Contact | CHELSEA M NAGEL Credentialing Manager 360-701-2002 |
Organization Subpart ? | No |
Primary Taxonomy | 261QD0000X Clinic/Center Dental |
Enumeration Date | 2015-11-24 |
Last Update Date | 2015-11-24 |