| Lakeshore Dental Practice | |
|
15322 Lakeshore Drive Suite 104 Clearlake CA 95422 | |
| (707) 994-6050 | |
| (707) 994-8049 |
| Full Name | Lakeshore Dental Practice |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15322 Lakeshore Drive, Clearlake, California |
| Authorized Official Name and Position | Richard J Ringrose (PRESIDENT OWNER) |
| Authorized Official Contact | 7079946050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Dental Practice 15322 Lakeshore Drive Suite 104 Clearlake CA 95422 Ph: (707) 994-6050 | Lakeshore Dental Practice 15322 Lakeshore Drive Suite 104 Clearlake CA 95422 Ph: (707) 994-6050 |
| NPI Number | 1033238837 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033238837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 23237 (California) | Primary |
Simon Lee Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 15130 Lakeshore Dr, Clearlake, CA 95422 Phone: 707-994-6000 Fax: 707-994-7589 |