Organization
LAKE ERIE DENTAL INC
Active
Parent organization
LAKE ERIE DENTAL INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE ERIE DENTAL INC
Authorized official
DR. KEVIN SAMBUCHINO DMD (PRESIDENT)
(814) 734-1814
Entity
Organization
Contact information
Practice address
106 WATERFORD STREET, EDINBORO, PA 16412
(814) 734-1814
(814) 734-7163
Mailing address
106 WATERFORD STREET, PO BOX 391, EDINBORO, PA 16412
(814) 734-1814
(814) 734-7163
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
017224
PA
1223G0001X
General Practice Dentistry
031305
PA
Other
Enumeration date
05/20/2008
Last updated
05/20/2008
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