| NPI | 1417169285 |
|---|---|
| Doing Business As | LAKESIDE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | AMY KROEGER Ins Cood 217-540-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2021-01-08 |