Organization
LAKESIDE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN SALAMON DMD (MANAGER)
(207) 310-0842
Entity
Organization
Contact information
Practice address
1051 WESTERN AVE, MANCHESTER, ME 04351-3403
(207) 310-0842
Mailing address
60 WILLOW LN, PORTLAND, ME 04102-2629
(207) 310-0842
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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