| NPI | 1619603156 |
|---|---|
| Doing Business As | LAKE ENDO |
| Entity Type | Organization |
| Authorized Contact | CANDIE GOODWIN Admin 704-987-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-08-23 |