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LAKESIDE DENTAL LLC

Ambulatory Health Care Facilities Clinic/Center Dental

Provider NPI: 1891262804

Organization Information:
Organization Name:  LAKESIDE DENTAL LLC
Organization is not Subpart
Authorized Official:  RYAN  SALAMON  MANAGER  207-310-0842

Practice Location:
1051 WESTERN AVE  MANCHESTER, ME 04351-3403 US
Tel: 207-310-0842  Fax: --

Business Mailing Address:
60 WILLOW LN  PORTLAND, ME 04102-2629 US
Tel: 207-310-0842  Fax: --

NPI Information:
NPI: 1891262804
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QD0000XAmbulatory Health Care Facilities
Clinic/Center
Dental

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 261QD0000X

Type:

Classification:



Definition:



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