Lakeshore Family Dental Care Sc

NPI 1215058532 - Dentist - 122300000X

NPI Details
NPI 1215058532
Enumeration Date 04/03/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name EDWARD J EDWARD
Position DENTIST
Phone (262) 639-1272
Fax
Practice Location
3903 DOUGLAS AVE
RACINE WI, 53402, US
Phone (262) 639-1272
Fax
Business Location
PO BOX 044290
RACINE WI, 53404, US
Phone (262) 639-1272
Fax (262) 639-8870
Toxanomy
Taxonomy Code 122300000X
License State Wisconsin
License Number 3520
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According to our database, Lakeshore Family Dental Care Sc NPI is 1215058532, taxonomy code is 122300000X and license number is 3520, license state is located at Wisconsin. Lakeshore Family Dental Care Sc physically located at 3903 Douglas Ave, Racine WI, 53402. NPI Number 1033115704 has the healthcare provider type.

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1215058532 NPI number is provided on an as is basis without warranty of any kind. 1215058532 is maintained by the National Plan & Provider Enumeration System. The contents of Lakeshore Family Dental Care Sc are for informational purposes only.