| 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 |