| NPI | 1730964115 |
|---|---|
| Doing Business As | EAGLE VALLEY DENTAL |
| Entity Type | Organization |
| Authorized Contact | JERRY LEE Owner 949-373-6985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2023-08-25 |