Organization
LAKESIDE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA VILLAGRAN (OFFICE MANAGER)
(414) 355-5020
Entity
Organization
Contact information
Practice address
5600 W BROWN DEER RD, SUITE 111, MILWAUKEE, WI 53223-2311
(414) 355-5020
Mailing address
5600 W BROWN DEER RD, SUITE 111, MILWAUKEE, WI 53223-2311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
100132615
WI
1223G0001X
General Practice Dentistry
Primary
5496
WI
Other
Enumeration date
06/17/2016
Last updated
06/17/2016
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