Organization
LAKESHORE DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF COHEN (COO)
(704) 246-8971
Entity
Organization
Contact information
Practice address
1200 GOLD HILL ROAD, FORT MILL, SC 29708
(803) 396-0000
(803) 396-0001
Mailing address
1200 GOLD HILL ROAD, FORT MILL, SC 29715
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/22/2018
Last updated
11/01/2021
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