# LAKE ERIE DENTAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LAKE ERIE DENTAL, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275700577
- **Legal business name:** LAKE ERIE DENTAL, INC.
- **Authorized official:** DR. KEVIN SAMBUCHINO D.M.D. (PRESIDENT)
- **Authorized official phone:** (814) 864-7511

## Contact information

- **Practice address:** 4944 PEACH ST, ERIE, PA 16509-2012
- **Practice address phone:** (814) 864-7511
- **Practice address fax:** (814) 866-1565
- **Mailing address:** 4944 PEACH ST, ERIE, PA 16509-2012
- **Mailing address phone:** (814) 864-7511
- **Mailing address fax:** (814) 866-1565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 031305 | PA | — |
| 1223G0001X | General Practice Dentistry | 17224 | PA | Yes |

## Other

- **Enumeration date:** 05/15/2008
- **Last updated:** 05/15/2008