Lakeshore Family Dental Center Greendale LLC

NPI #1932982113 in Greendale, Wisconsin

Provider Information

NPI Number: 1932982113
Entity Type: Organization
Organization Name: Lakeshore Family Dental Center Greendale LLC
Primary Specialty: Dentist
Enumeration Date: Aug 14, 2023
Last Updated: Aug 22, 2023

Practice Location

Address: 5808 BROAD ST
City: Greendale
State: Wisconsin
ZIP Code: 53129-2404
Phone: (414) 421-2303

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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