Mountain Lake Denture Services, Pllc

NPI #1962715805 in Prosser, Washington

Provider Information

NPI Number: 1962715805
Entity Type: Organization
Organization Name: Mountain Lake Denture Services, Pllc
Primary Specialty: Denturist
Enumeration Date: Jul 21, 2010
Last Updated: Jul 21, 2010

Practice Location

Address: 1225 MEADE AVE
City: Prosser
State: Washington
ZIP Code: 99350-1423
Phone: (509) 786-2963

Authorized Official

Name: JOSHUA D BROOKS, DPD
Title: MEMBER
Phone: (509) 303-9090

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Denturist	122400000X	Primary

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