# LAKE ERIE DENTAL INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LAKE ERIE DENTAL INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568629335
- **Legal business name:** LAKE ERIE DENTAL INC
- **Authorized official:** DR. KEVIN SAMBUCHINO DMD (PRESIDENT)
- **Authorized official phone:** (814) 734-1814

## Contact information

- **Practice address:** 106 WATERFORD STREET, EDINBORO, PA 16412
- **Practice address phone:** (814) 734-1814
- **Practice address fax:** (814) 734-7163
- **Mailing address:** 106 WATERFORD STREET, PO BOX 391, EDINBORO, PA 16412
- **Mailing address phone:** (814) 734-1814
- **Mailing address fax:** (814) 734-7163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 017224 | PA | Yes |
| 1223G0001X | General Practice Dentistry | 031305 | PA | — |

## Other

- **Enumeration date:** 05/20/2008
- **Last updated:** 05/20/2008