Organization
LAKESIDE PEDIATRIC DENTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP GLENN MONROY DDS, MS (OWNER)
(810) 985-9660
Entity
Organization
Contact information
Practice address
1952 HOLLAND AVE, PORT HURON, MI 48060-1520
(810) 985-9660
(810) 985-9666
Mailing address
1952 HOLLAND AVE, PORT HURON, MI 48060-1520
(810) 985-9660
(810) 985-9666
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2901018671
MI
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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