# LAKEVIEW DENTAL

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

## Provider details

- **NPI number:** 1801241922
- **Authorized official:** DR. SPENCER WIRIG DMD (OWNER)
- **Authorized official phone:** (208) 664-0884

## Contact information

- **Practice address:** 801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
- **Practice address phone:** (208) 664-0884
- **Practice address fax:** (208) 664-3304
- **Mailing address:** 801 W MILWAUKEE DR, COEUR D'ALENE, ID 83814

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4020 | ID | Yes |
| 332BC3200X | Customized Equipment (DME) | D4020 | ID | — |

## Other

- **Enumeration date:** 04/26/2016
- **Last updated:** 04/26/2016