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Organization
LAKE COUNTRY DENTISTRY, L.L.C.
Active
Organization
LAKE COUNTRY DENTISTRY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES JON COTEY (GENERAL MANAGER)
(262) 567-6003
Entity
Organization
Contact information
Practice address
175 E WISCONSIN AVE, OCONOMOWOC, WI 53066-3057
(262) 567-6003
(262) 567-6018
Mailing address
175 E WISCONSIN AVE, OCONOMOWOC, WI 53066-3057
(262) 567-6003
(262) 567-6018
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/09/2007
Last updated
08/22/2020
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