# LAKES REGIONAL ORAL & MAXILLOFACIAL SURGERY, PC

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

## Provider details

- **NPI number:** 1760637185
- **Authorized official:** STEVEN R EVELHOCH MD (OWNER)
- **Authorized official phone:** (712) 264-8390

## Contact information

- **Practice address:** 116 E 11TH ST, SUITE 203, SPENCER, IA 51301-4364
- **Practice address phone:** (712) 264-8390
- **Practice address fax:** (712) 264-8391
- **Mailing address:** 116 E 11TH ST, SUITE 203, SPENCER, IA 51301-4364
- **Mailing address phone:** (712) 264-8390
- **Mailing address fax:** (712) 264-8391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | IA | Yes |

## Other

- **Enumeration date:** 11/26/2008
- **Last updated:** 11/26/2008