# LAKE GENEVA DENTAL CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beloit Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326473927
- **Authorized official:** DR. LAWRENCE GROH DDS (OWNER/PRESIDENT)
- **Authorized official phone:** (630) 833-5110

## Contact information

- **Practice address:** 1454 E HUEBBE PKWY, BELOIT, WI 53511-1714
- **Practice address phone:** (608) 362-0672
- **Practice address fax:** (608) 362-4960
- **Mailing address:** 333 W 1ST ST, ELMHURST, IL 60126-2641
- **Mailing address phone:** (630) 833-5110
- **Mailing address fax:** (630) 833-0458

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 019014858 | IL | Yes |

## Other

- **Enumeration date:** 09/13/2013
- **Last updated:** 09/13/2013