Lake Road Dental LLC
NPI #1174016737 in Dillingham, Alaska
Provider Information
- NPI Number
- 1174016737
- Entity Type
- Organization
- Organization Name
- Lake Road Dental LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Jun 8, 2018
- Last Updated
- Jun 8, 2018
Practice Location
- Address
- 4622 SHANNON LAKE RD
- City
- Dillingham
- State
- Alaska
- ZIP Code
- 99576
- Phone
- (907) 842-2324
Authorized Official
- Name
- KELLY LUCAS, DDS
- Title
- DENTIST/ OWNER
- Phone
- (907) 842-2324
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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