Organization
LAKESIDE SMILES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY DIPASQUALE KIM DDS (OWNER, DENTIST)
(443) 979-9155
Entity
Organization
Contact information
Practice address
7135 MINSTREL WAY STE 101, COLUMBIA, MD 21045-5293
(443) 832-3305
Mailing address
11716 PINDELL CHASE DR, FULTON, MD 20759-9704
(703) 943-8360
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/24/2019
Last updated
10/16/2019
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