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Organization
LAKE CITY DENTAL SPECIALTIES, PC
Active
Organization
LAKE CITY DENTAL SPECIALTIES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAUN MICHAEL WHITNEY DDS (PRESIDENT)
(208) 664-7300
Entity
Organization
Contact information
Practice address
1322 W KATHLEEN AVE STE 2, COEUR D ALENE, ID 83815-7365
(208) 664-7300
(208) 664-7333
Mailing address
1322 W KATHLEEN AVE STE 2, COEUR D ALENE, ID 83815-7365
(208) 664-7300
(208) 664-7333
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
D4420EN
ID
1223P0300X
Periodontics
Primary
D4420PE
ID
Other
Enumeration date
10/07/2012
Last updated
10/07/2012
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