| NPI | 1144816497 |
|---|---|
| Doing Business As | LAKESIDE DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | TABATHA LEMKE Credentialing Coordinator 217-540-6078 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2020-12-21 |