| NPI | 1780130625 |
|---|---|
| Former Legal Business Name | PARK STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | EDWARD E FLETCHER Doctor 360-748-6629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |