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Organization
LAKESIDE DENTAL
Active
Organization
LAKESIDE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI MUNSON (OFFICE MANAGER)
(509) 764-0307
Entity
Organization
Contact information
Practice address
1708 SOUTH CLOVER DRIVE, MOSES LAKE, WA 98837
(509) 764-0307
(509) 764-0886
Mailing address
1708 SOUTH CLOVER DRIVE, MOSES LAKE, WA 98837
(509) 764-0307
(509) 764-0886
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00010850
WA
1223G0001X
General Practice Dentistry
DE60028802
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5056627
—
WA
Enumeration date
08/19/2008
Last updated
08/19/2008
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