| NPI | 1548819568 |
|---|---|
| Doing Business As | PUYALLUP MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | DULCE GOMEZ Credentialing Supervisor 714-845-8701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2019-09-11 |