| NPI | 1316305063 |
|---|---|
| Doing Business As | THE LAKES DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-29 |