| NPI | 1831391499 |
|---|---|
| Other Name | LAKE AREA PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | THANE CRUMP Dentist, Owner 605-753-6824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SD M 750) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SD M 750) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |