Lake Dental Group

LBN: Lake Dental Group
Lake Dental Group is an health care organization with primary practice located at 400 Lake Ave , Racine WI 53403-1020. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Lake Dental Group can be contacted via phone (262) 633-0775, or through Poole, Lilly via phone (262) 633-0775.

Contact Information

Primary practice address
400 Lake Ave Racine WI 53403-1020
Phone: (262) 633-0775
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Poole, Lilly
Phone: (262) 633-0775

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X

Profile Details

NPI number 1922314210
LBN Legal business name Lake Dental Group
DBA Doing business as
Authorized official Poole, Lilly
Entity Organization
Organization subpart 1 No
Enumeration date Aug 24th, 2010
Last updated Aug 24th, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922314210 NPPES
Wisconsin MEDICAID 33605400

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