Organization
ESTATE OF KEVIN L. CHANCELLOR
Active
Other names
Lakeside Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANIELLE M CHANCELLOR CDA-EFDA (OFFICE ADMINISTRATOR)
(541) 994-8135
Entity
Organization
Contact information
Practice address
3173 NE WEST DEVILS LAKE RD, LINCOLN CITY, OR 97367
(541) 994-8135
(541) 994-8136
Mailing address
3173 NE WEST DEVILS LAKE RD, LINCOLN CITY, OR 97367
(541) 994-8135
(541) 994-8136
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5874
OR
Other
Enumeration date
02/19/2009
Last updated
02/19/2009
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