| NPI | 1548010432 |
|---|---|
| Doing Business As | LAKE MOUNTAIN DENTAL |
| Entity Type | Organization |
| Authorized Contact | HILLARY THULL Credentialing Coordinator 217-540-8946 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-03-25 |