| Lakeside Pediatric Dental Specialists | |
|
1952 Holland Ave Port Huron MI 48060-1520 | |
| (810) 985-9660 | |
| (810) 985-9666 |
| Full Name | Lakeside Pediatric Dental Specialists |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1952 Holland Ave, Port Huron, Michigan |
| Authorized Official Name and Position | Phillip Glenn Monroy (OWNER) |
| Authorized Official Contact | 8109859660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Pediatric Dental Specialists 1952 Holland Ave Port Huron MI 48060-1520 Ph: (810) 985-9660 | Lakeside Pediatric Dental Specialists 1952 Holland Ave Port Huron MI 48060-1520 Ph: (810) 985-9660 |
| NPI Number | 1891194379 |
|---|---|
| Provider Enumeration Date | 08/20/2014 |
| Last Update Date | 08/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891194379 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 2901018671 (Michigan) | Primary |
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