| NPI | 1982175170 |
|---|---|
| Doing Business As | SOUTHLAKE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | PRIYA P CHOUGULE Owner/Dentist 201-675-7256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |