Organization
LIGHTHOUSE DENTAL 63090
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELISSA K ZYK DDS (OWNER)
(636) 390-9991
Entity
Organization
Contact information
Practice address
560 E 14TH ST, WASHINGTON, MO 63090-4535
(636) 390-9991
Mailing address
560 E 14TH ST, WASHINGTON, MO 63090-4535
(636) 390-9991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578977104
BRITTANY BOCKHORST
MO
01
—
1770564858
MELISSA ZYK
MO
Enumeration date
08/03/2022
Last updated
08/03/2022
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