| NPI | 1568926046 |
|---|---|
| Doing Business As | LIBERTY LAKE SMILE SOURCE |
| Entity Type | Organization |
| Authorized Contact | LORI A CHRISTOPHERSON Office Manager 509-927-9279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2020-12-30 |