Organization
LAKE ROAD DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY LUCAS DDS (DENTIST/ OWNER)
(907) 842-2324
Entity
Organization
Contact information
Practice address
4622 SHANNON LAKE RD, DILLINGHAM, AK 99576
(907) 842-2324
Mailing address
PO BOX 969, DILLINGHAM, AK 99576-0969
(907) 842-2324
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/08/2018
Last updated
06/08/2018
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