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Organization
LAKESIDE FAMILY DENTISTRY, LLC
Active
Organization
LAKESIDE FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MILLER (OWNER)
(864) 305-1402
Entity
Organization
Contact information
Practice address
4371 HIGHWAY 24, ANDERSON, SC 29626-5214
(864) 305-1402
Mailing address
4371 HIGHWAY 24, ANDERSON, SC 29626-5214
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4489
SC
Other
Enumeration date
06/28/2013
Last updated
06/28/2013
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