# LAKESIDE DC LLC

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

## Provider details

- **NPI number:** 1134001266
- **Authorized official:** DR. BENJAMIN BACON DDS (DOCTOR/OWNER)
- **Authorized official phone:** (361) 815-9929

## Contact information

- **Practice address:** 4309 BRINTON DR STE 103, GREENSBORO, NC 27410-9302
- **Practice address phone:** (361) 815-9929
- **Mailing address:** 817 BASS LANDING PL, GREENSBORO, NC 27455-3440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/21/2025
- **Last updated:** 07/27/2025