Lakeshore Community Dental Clinic

NPI #1023275013 in Cleveland, Wisconsin

Provider Information

NPI Number
1023275013
Entity Type
Organization
Organization Name
Lakeshore Community Dental Clinic
Primary Specialty
Clinic/Center - Dental
Enumeration Date
May 19, 2008
Last Updated
May 19, 2008

Practice Location

Address
1290 NORTH AVE
Address 2
LAKESHORE COMMUNITY DENTAL CLINIC
ZIP Code
53015-1412
Phone
(920) 693-1386

Authorized Official

Name
MS. BARBARA J DODGE, PH.D., R.N.
Title
DEAN, HEALTH AND HUMAN SERVICES
Phone
(920) 693-1386

Specialties & Taxonomy Codes

Specialty
Clinic/Center - DentalDental

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