Organization
LAKESHORE DENTAL STUDIO
Active
Other names
Lakeshore Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CONNOR VAN DMD (DENTIST)
(617) 416-8016
Entity
Organization
Contact information
Practice address
1221 W FAIRBANKS AVE, ORLANDO, FL 32804-1205
(407) 794-1515
Mailing address
1221 W FAIRBANKS AVE, ORLANDO, FL 32804-1205
(407) 794-1515
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/16/2019
Last updated
10/16/2019
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