Organization
LAKESHORE MALL DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA CHATHAM (DIST MANAGER)
(770) 536-1957
Entity
Organization
Contact information
Practice address
150 PEARL NIX PKWY, SUITE B10, GAINESVILLE, GA 30501-3548
(770) 536-1957
(770) 536-3582
Mailing address
150 PEARL NIX PKWY, SUITE B10, GAINESVILLE, GA 30501-3548
(770) 536-1957
(770) 536-3582
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/05/2007
Last updated
08/22/2020
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