NPI | 1902003593 |
---|---|
Doing Business As | SIERRA LAKES DENTAL GROUP |
Entity Type | Organization |
Authorized Contact | WALTER JEFFERSON Owner 909-357-0869 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2007-06-28 |
Last Update Date | 2020-08-22 |