Organization
LAKESIDE PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA LOCHER (OFFICE MANAGER)
(478) 743-0901
Entity
Organization
Contact information
Practice address
1050 PARKSIDE CMNS, SUITE 103, GREENSBORO, GA 30642-4524
(706) 454-2222
(706) 454-1234
Mailing address
1050 PARKSIDE CMNS, SUITE 103, GREENSBORO, GA 30642-4524
(706) 454-2222
(706) 454-1234
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012737
GA
Other
Enumeration date
03/17/2017
Last updated
03/17/2017
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