| NPI | 1972145407 |
|---|---|
| Doing Business As | LAKESHORE DENTAL |
| Entity Type | Organization |
| Authorized Contact | CONNOR VAN Dentist 617-416-8016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2019-10-16 |