| Lakeshore Technical College | |
|
1290 North Ave Lakeshore Community Dental Clinic Cleveland WI 53015-1412 | |
| (920) 693-1386 | |
| Not Available |
| Full Name | Lakeshore Technical College |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1290 North Ave, Cleveland, Wisconsin |
| Authorized Official Name and Position | Barbara J Dodge (DEAN, HEALTH AND HUMAN SERVICES) |
| Authorized Official Contact | 9206931386 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Technical College 1290 North Ave Lakeshore Community Dental Clinic Cleveland WI 53015-1412 Ph: (920) 693-1386 | Lakeshore Technical College 1290 North Ave Lakeshore Community Dental Clinic Cleveland WI 53015-1412 Ph: (920) 693-1386 |
| NPI Number | 1023275013 |
|---|---|
| Provider Enumeration Date | 05/19/2008 |
| Last Update Date | 05/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023275013 | NPI | - | NPPES |
| 38394700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |