Organization
LAKESHORE COMMUNITY DENTAL CLINIC
Active
Other names
Lakeshore Technical College
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA J DODGE PH.D., R.N. (DEAN, HEALTH AND HUMAN SERVICES)
(920) 693-1386
Entity
Organization
Contact information
Practice address
1290 NORTH AVE, LAKESHORE COMMUNITY DENTAL CLINIC, CLEVELAND, WI 53015-1412
(920) 693-1386
Mailing address
1290 NORTH AVE, LAKESHORE COMMUNITY DENTAL CLINIC, CLEVELAND, WI 53015-1412
(920) 693-1386
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38394700
—
WI
Enumeration date
05/19/2008
Last updated
05/19/2008
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