| NPI | 1144426214 |
|---|---|
| Doing Business As | LAKESIDE DENTAL |
| Entity Type | Organization |
| Authorized Contact | SHERRI LYNN POETTKER Dentist Owner 636-561-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2003000402) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-08-22 |