| NPI | 1992364319 |
|---|---|
| Doing Business As | LAKESIDE DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | JESSICA BRITT Credentialing Coordinator 217-540-5100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2019-08-22 |