Organization
LAKE ERIE DENTAL, INC.
Active
Parent organization
LAKE ERIE DENTAL, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE ERIE DENTAL, INC.
Authorized official
DR. KEVIN SAMBUCHINO D.M.D. (PRESIDENT)
(814) 864-7511
Entity
Organization
Contact information
Practice address
4944 PEACH ST, ERIE, PA 16509-2012
(814) 864-7511
(814) 866-1565
Mailing address
4944 PEACH ST, ERIE, PA 16509-2012
(814) 864-7511
(814) 866-1565
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
031305
PA
1223G0001X
General Practice Dentistry
Primary
17224
PA
Other
Enumeration date
05/15/2008
Last updated
05/15/2008
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