# LAKEWOOD DENTAL ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakewood Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053968917
- **Authorized official:** CHARLYNE JUNGERMANN (PRACTICE MANAGER)
- **Authorized official phone:** (440) 899-7950

## Contact information

- **Practice address:** 15711 MADISON AVE, LAKEWOOD, OH 44107-5655
- **Practice address phone:** (216) 228-7950
- **Mailing address:** 15711 MADISON AVE STE 104, LAKEWOOD, OH 44107-5655
- **Mailing address phone:** (216) 228-7950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/24/2019
- **Last updated:** 08/24/2019