Organization
LAKESIDE DC LLC
Active
Other names
Lakeside Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN BACON DDS (DOCTOR/OWNER)
(361) 815-9929
Entity
Organization
Contact information
Practice address
4309 BRINTON DR STE 103, GREENSBORO, NC 27410-9302
(361) 815-9929
Mailing address
817 BASS LANDING PL, GREENSBORO, NC 27455-3440
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/21/2025
Last updated
07/27/2025
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