Lake Road Dental Llc | |
4622 Shannon Lake Rd Dillingham AK 99576 | |
(907) 842-2324 | |
Not Available |
Full Name | Lake Road Dental Llc |
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Speciality | Clinic/center - Dental |
Location | 4622 Shannon Lake Rd, Dillingham, Alaska |
Authorized Official Name and Position | Kelly Lucas (DENTIST/ OWNER) |
Authorized Official Contact | 9078422324 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lake Road Dental Llc Po Box 969 Dillingham AK 99576-0969 Ph: (907) 842-2324 | Lake Road Dental Llc 4622 Shannon Lake Rd Dillingham AK 99576 Ph: (907) 842-2324 |
NPI Number | 1174016737 |
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Provider Enumeration Date | 06/08/2018 |
Last Update Date | 06/08/2018 |
Identifier | Type | State | Issuer |
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1174016737 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Dental Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6000 Kanakanak Rd, Dillingham, AK 99576 Phone: 907-842-5201 Fax: 907-842-9250 |