Lakeshore Family Dental Center LLC

NPI #1306629589 in Glendale, Wisconsin

Provider Information

NPI Number: 1306629589
Entity Type: Organization
Organization Name: Lakeshore Family Dental Center LLC
Primary Specialty: Dentist
Enumeration Date: Aug 14, 2023
Last Updated: Aug 22, 2023

Practice Location

Address: 7155 N PORT WASHINGTON RD
City: Glendale
State: Wisconsin
ZIP Code: 53217-3841
Phone: (414) 352-1600

Authorized Official

Name: MIKE COLE
Title: VP INSURANCE PLAN MANAGEMENT
Phone: (727) 424-2990

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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