# LAKEVIEW DENTAL ASSOCIATES

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

## Provider details

- **NPI number:** 1407006281
- **Authorized official:** MRS. SUSAN DIANNE DRAPER (OFFICE MANAGER)
- **Authorized official phone:** (989) 352-7294

## Contact information

- **Practice address:** 924 S LINCOLN AVE, LAKEVIEW, MI 48850-9174
- **Practice address phone:** (989) 352-7294
- **Practice address fax:** (989) 352-8348
- **Mailing address:** 924 S LINCOLN AVE, PO BOX 530, LAKEVIEW, MI 48850-9174
- **Mailing address phone:** (989) 352-7294
- **Mailing address fax:** (989) 352-8348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 18409 | MI | — |
| 1223G0001X | General Practice Dentistry | 9226 | MI | Yes |

## Other

- **Enumeration date:** 09/29/2008
- **Last updated:** 09/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 124494419 | — | MI |
| 01 | — | 1955910090 | BCBS MEDICAL | MI |
| 01 | — | 195597120 | BCBS MEDICAL | MI |
| 05 | — | 4006325 | — | MI |
| 01 | — | D092260 | BC BS DENTAL | MI |
| 01 | — | D184090 | BCBS DENTAL | MI |