| Lakeside Pediatric Dentistry, Llc | |
|
1050 Parkside Cmns Suite 103 Greensboro GA 30642-4524 | |
| (706) 454-2222 | |
| (706) 454-1234 |
| Full Name | Lakeside Pediatric Dentistry, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1050 Parkside Cmns, Greensboro, Georgia |
| Authorized Official Name and Position | Tina Locher (OFFICE MANAGER) |
| Authorized Official Contact | 4787430901 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Pediatric Dentistry, Llc 1050 Parkside Cmns Suite 103 Greensboro GA 30642-4524 Ph: (706) 454-2222 | Lakeside Pediatric Dentistry, Llc 1050 Parkside Cmns Suite 103 Greensboro GA 30642-4524 Ph: (706) 454-2222 |
| NPI Number | 1174064539 |
|---|---|
| Provider Enumeration Date | 03/17/2017 |
| Last Update Date | 03/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174064539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN012737 (Georgia) | Primary |
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