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 |