| NPI | 1861290553 |
|---|---|
| Doing Business As | PORT SUSAN DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOSEPH R EIDSNESS Practice Owner 360-618-2877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-03-06 |
| Last Update Date | 2025-03-08 |