| Lakeside Endodontics | |
|
1245 Cheyenne Ave Suite 104 Grafton WI 53024-9323 | |
| (262) 377-2889 | |
| (262) 377-2680 |
| Full Name | Lakeside Endodontics |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 1245 Cheyenne Ave, Grafton, Wisconsin |
| Authorized Official Name and Position | Kelly Nicole West (OWNER) |
| Authorized Official Contact | 2623772668 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Endodontics 1245 Cheyenne Ave Suite 104 Grafton WI 53024-9323 Ph: (262) 377-2889 | Lakeside Endodontics 1245 Cheyenne Ave Suite 104 Grafton WI 53024-9323 Ph: (262) 377-2889 |
| NPI Number | 1417284480 |
|---|---|
| Provider Enumeration Date | 11/11/2009 |
| Last Update Date | 11/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417284480 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 6129-15 (Wisconsin) | Primary |
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