Organization
LAKEHAVEN DENTAL P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEFAN S HACKER DDS (PRESIDENT)
(918) 787-7900
Entity
Organization
Contact information
Practice address
200 E 3RD STREET, GROVE, OK 74344
(918) 787-7900
(918) 787-5871
Mailing address
PO BOX 451897, GROVE, OK 74345-1897
(918) 787-7900
(918) 787-5871
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200253590A
—
OK
Enumeration date
04/13/2007
Last updated
11/03/2015
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