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Organization
LAKE CITY DENTAL CLINIC
Active
Organization
LAKE CITY DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA WHIDDON (EXECUTIVE DIRECTOR)
(970) 944-2331
Entity
Organization
Contact information
Practice address
700 N HENSON ST, LAKE CITY, CO 81235-5134
(970) 944-2331
(970) 944-2320
Mailing address
PO BOX 999, LAKE CITY, CO 81235-0999
(970) 944-2331
(970) 944-2320
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/30/2020
Last updated
10/30/2020
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