| NPI | 1639444235 |
|---|---|
| Doing Business As | FAYETTE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | CHARLES LEE President 563-425-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IA 08790) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2012-03-14 |