| NPI | 1205307816 |
|---|---|
| Doing Business As | COMPLETE DENTAL AT LAKESIDE |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Enrollment Team Lead 217-540-8513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2018-12-07 |