| NPI | 1730506064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW SHANE EPSTEIN Owner 120-696-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WA DE 60277222) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2014-03-25 |