Lakes Region Dental Implant and Oral Surgery Center, P.a.

NPI #1265721534 in Gilford, New Hampshire

Provider Information

NPI Number
1265721534
Entity Type
Organization
Organization Name
Lakes Region Dental Implant and Oral Surgery Center, P.a.
Primary Specialty
Dentist - Oral and Maxillofacial Pathology
Enumeration Date
Apr 7, 2011
Last Updated
Apr 7, 2011

Practice Location

Address
369 HOUNSELL AVE
Address 2
SUITE 2
ZIP Code
03249
Phone
(603) 527-8057

Authorized Official

Name
DR. DANIEL HENRY DETOLLA, DDS, MD
Title
PRESIDENT
Phone
(603) 436-3608

Specialties & Taxonomy Codes

Specialty
Dentist - Oral and Maxillofacial PathologyOral and Maxillofacial Pathology

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