# LAKE DENTAL PLLC

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

## Provider details

- **NPI number:** 1518132117
- **Authorized official:** DR. ROBERT DAVID LACOSSE (CEO)
- **Authorized official phone:** (218) 728-4272

## Contact information

- **Practice address:** 2200 LONDON RD, DULUTH, MN 55812-2129
- **Practice address phone:** (218) 728-4272
- **Mailing address:** 2200 LONDON ROAD, DULUTH, MN 55812-2129

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D10551 | MN | Yes |

## Other

- **Enumeration date:** 04/24/2008
- **Last updated:** 04/24/2008