# LAKE CITY DENTAL CLINIC

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

## Provider details

- **NPI number:** 1376143081
- **Authorized official:** JESSICA WHIDDON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (970) 944-2331

## Contact information

- **Practice address:** 700 N HENSON ST, LAKE CITY, CO 81235-5134
- **Practice address phone:** (970) 944-2331
- **Practice address fax:** (970) 944-2320
- **Mailing address:** PO BOX 999, LAKE CITY, CO 81235-0999
- **Mailing address phone:** (970) 944-2331
- **Mailing address fax:** (970) 944-2320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/30/2020
- **Last updated:** 10/30/2020