# LAKSHORE FAMILY DENTAL

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

## Provider details

- **NPI number:** 1356614838
- **Authorized official:** DR. ANDREW BARGREN (OWNER)
- **Authorized official phone:** (269) 429-4661

## Contact information

- **Practice address:** 5638 CLEVELAND AVE, STEVENSVILLE, MI 49127-9696
- **Practice address phone:** (269) 429-4661
- **Practice address fax:** (269) 429-4486
- **Mailing address:** 5638 CLEVELAND AVE, STEVENSVILLE, MI 49127-9696
- **Mailing address phone:** (269) 429-4661
- **Mailing address fax:** (269) 429-4486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901019195 | MI | Yes |

## Other

- **Enumeration date:** 02/15/2012
- **Last updated:** 02/15/2012