| NPI | 1558033050 |
|---|---|
| Doing Business As | EAST LAKE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | ELISHA ELISHA BUCKLEY Owner 678-524-7364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-10-02 |
| Last Update Date | 2021-10-02 |