Organization
LAKELAND FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMANTHA JEAN RUIZ DDS (OWNER)
(262) 705-9076
Entity
Organization
Contact information
Practice address
1300 N SUMMIT AVE, SUITE 101, OCONOMOWOC, WI 53066-4467
(262) 567-1323
Mailing address
910 OCONOMOWOC PKWY, OCONOMOWOC, WI 53066-4615
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6544-15
WI
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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