| NPI | 1144063298 |
|---|---|
| Doing Business As | LAKESIDE DENTAL ASSOCIATES |
| Entity Type | Organization |
| Authorized Contact | MICHAEL WOLFGRAM President/Owner 810-814-3053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-06-17 |