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 |