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Organization
LAKE PARK DENTAL LLC
Active
Organization
LAKE PARK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN E GRAHAM (OWNER)
(414) 963-9440
Entity
Organization
Contact information
Practice address
2524 E WEBSTER PL STE 201, MILWAUKEE, WI 53211-4257
(414) 963-9440
Mailing address
2524 E WEBSTER PL STE 201, MILWAUKEE, WI 53211-4257
(414) 963-9440
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/07/2019
Last updated
08/07/2019
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