| NPI | 1649717638 |
|---|---|
| Doing Business As | LAUREL LAKES PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ANTIONETTE C. WILSON Owner 202-276-0649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 13970) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2018-07-20 |