| NPI | 1811490550 |
|---|---|
| Doing Business As | LAKE STEVENS MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | DULCE GOMEZ Credentialing Coordinator 714-845-8701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2018-03-08 |