Organization
LAKESIDE FAMILY DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN JOHNSON (BUSINESS ADVISOR)
(877) 221-7750
Entity
Organization
Contact information
Practice address
2812 W HEFNER RD, OKLAHOMA CITY, OK 73120-6318
(405) 751-0358
Mailing address
2812 W HEFNER RD, OKLAHOMA CITY, OK 73120-6318
(405) 751-0358
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6796
OK
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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