| NPI | 1679096523 |
|---|---|
| Doing Business As | LAKEVIEW DENTAL |
| Entity Type | Organization |
| Authorized Contact | ALVIN BRETT MATTESON Owner/ Prosthodontist 270-853-2508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: ID D-4027) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4027) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-07-21 |