# LAKES REGION DENTAL IMPLANT AND ORAL SURGERY CENTER, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265721534
- **Authorized official:** DR. DANIEL HENRY DETOLLA DDS, MD (PRESIDENT)
- **Authorized official phone:** (603) 436-3608

## Contact information

- **Practice address:** 369 HOUNSELL AVE, SUITE 2, GILFORD, NH 03249
- **Practice address phone:** (603) 527-8057
- **Practice address fax:** (603) 527-8159
- **Mailing address:** 369 HOUNSELL AVE, SUITE 2, GILFORD, NH 03249
- **Mailing address phone:** (603) 527-8057
- **Mailing address fax:** (603) 527-8159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | Yes |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/07/2011
- **Last updated:** 04/07/2011