# LAKE CITY DENTAL

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

## Provider details

- **NPI number:** 1275871329
- **Authorized official:** GARY BILLS DDS (MANAGER)
- **Authorized official phone:** (208) 664-6476

## Contact information

- **Practice address:** 6176 GOVERNMENT WAY, COEUR D'ALENE, ID 83815
- **Practice address phone:** (208) 664-6476
- **Mailing address:** 6176 GOVERNMENT WAY, COEUR D'ALENE, ID 83815
- **Mailing address phone:** (208) 664-6476

## Taxonomy

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

## Other

- **Enumeration date:** 01/24/2013
- **Last updated:** 07/21/2022