| NPI | 1518641083 |
|---|---|
| Doing Business As | LAKE MOUNTAIN DENTAL |
| Entity Type | Organization |
| Authorized Contact | CADEN CADEN Admin 801-830-4486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-06-14 |