| NPI | 1386185106 |
|---|---|
| Other Name | LAKE DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | MARGARET ABOAGYE CEO 262-633-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1629150289) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |