| NPI | 1912489659 |
|---|---|
| Doing Business As | LAKESIDE DENTAL GREENACRES |
| Entity Type | Organization |
| Authorized Contact | OWEN EARL PACKARD Owner 509-922-2211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2018-10-18 |