| NPI | 1790569465 |
|---|---|
| Former Legal Business Name | LAKEVIEW DENTAL |
| Entity Type | Organization |
| Authorized Contact | CARLOS DEGOLLADO Owner Dentist 860-679-3749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-08-23 |