Lake Meridian Dental LLC

NPI #1093110215 in Kent, Washington

Provider Information

NPI Number: 1093110215
Entity Type: Organization
Organization Name: Lake Meridian Dental LLC
Primary Specialty: Dentist
Enumeration Date: Oct 30, 2014
Last Updated: Oct 30, 2014

Practice Location

Address: 12906 SE KENT KANGLEY RD
City: Kent
State: Washington
ZIP Code: 98030-7940
Phone: (253) 631-3015

Authorized Official

Name: TRAVIS JOHN PROBST, DDS
Title: DENTIST
Phone: (253) 631-3015

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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