| NPI | 1841845211 |
|---|---|
| Doing Business As | SMILE SOURCE NORTH |
| Doing Business As | SMILE SOURCE SPOKANE |
| Entity Type | Organization |
| Authorized Contact | ERIC ELLINGSEN Owner 509-924-2866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2019-08-02 |