| NPI | 1508137142 |
|---|---|
| Doing Business As | GRAND LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | WONJOO LEE President 510-208-3012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 49923) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |