# LAKE COUNTRY DENTAL P.L.L.C

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

## Provider details

- **NPI number:** 1396274452
- **Authorized official:** DR. LISA KAY MULKIN D.D.S. (OWNER/DENTIST)
- **Authorized official phone:** (315) 789-3067

## Contact information

- **Practice address:** 404 WILLIAM ST STE 5, GENEVA, NY 14456-2143
- **Practice address phone:** (315) 789-3067
- **Practice address fax:** (315) 789-0056
- **Mailing address:** 404 WILLIAM ST STE 5, GENEVA, NY 14456-2143
- **Mailing address phone:** (315) 789-3067
- **Mailing address fax:** (315) 789-0056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 050514 | NY | Yes |

## Other

- **Enumeration date:** 06/12/2017
- **Last updated:** 07/21/2022