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Organization
LAKE DENTAL SERVICES, P.A.
Active
Organization
LAKE DENTAL SERVICES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GOMEZ (PROVIDER RELATIONS)
(305) 274-2499
Entity
Organization
Contact information
Practice address
820 STATE RD. 434 N., SUITE B, ALTAMONTE SPRINGS, FL 32714
(407) 865-9100
Mailing address
13195 SW 134 ST, 2ND FLOOR, MIAMI, FL 33186
(305) 274-2499
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
08/17/2006
Last updated
08/21/2014
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