| NPI | 1568928752 |
|---|---|
| Doing Business As | LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOSHUA COLT SWEETEN Owner 208-351-5311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2019-02-13 |