Organization
LAKE CITY DENTAL SPECIALTIES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAUN MICHAEL WHITNEY DDS (PRESIDENT)
(208) 664-7300
Entity
Organization
Contact information
Practice address
1322 W KATHLEEN AVE STE 2, COEUR D ALENE, ID 83815-7365
(208) 664-7300
(208) 664-7333
Mailing address
1322 W KATHLEEN AVE STE 2, COEUR D ALENE, ID 83815-7365
(208) 664-7300
(208) 664-7333
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
D4420EN
ID
1223P0300X
Periodontics
Primary
D4420PE
ID
Other
Enumeration date
10/07/2012
Last updated
10/07/2012
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