NPI | 1417284480 |
---|---|
Doing Business As | LAKESIDE ENDODONTICS |
Entity Type | Organization |
Authorized Contact | KELLY NICOLE WEST Owner 262-377-2668 |
Organization Subpart ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 6129-15) |
Enumeration Date | 2009-11-11 |
Last Update Date | 2009-11-11 |