Organization
LAKEVIEW DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN DIANNE DRAPER (OFFICE MANAGER)
(989) 352-7294
Entity
Organization
Contact information
Practice address
924 S LINCOLN AVE, LAKEVIEW, MI 48850-9174
(989) 352-7294
(989) 352-8348
Mailing address
924 S LINCOLN AVE, PO BOX 530, LAKEVIEW, MI 48850-9174
(989) 352-7294
(989) 352-8348
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
18409
MI
1223G0001X
General Practice Dentistry
Primary
9226
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124494419
—
MI
01
—
1955910090
BCBS MEDICAL
MI
01
—
195597120
BCBS MEDICAL
MI
05
—
4006325
—
MI
01
—
D092260
BC BS DENTAL
MI
01
—
D184090
BCBS DENTAL
MI
Enumeration date
09/29/2008
Last updated
09/29/2008
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