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Organization
PROFESSIONAL DENTAL ALLIANCE OF LAKE WASHINGTON, PLLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF LAKE WASHINGTON, PLLC
Active
Other names
New Image Dentistry Lake Washington
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE MARLOW (CREDENTIALING SUPERVISOR)
(724) 698-2119
Entity
Organization
Contact information
Practice address
3226 LAKE WASHINGTON RD STE 16, MELBOURNE, FL 32934-7620
(321) 255-1991
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
(724) 698-2500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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