Healthcare Provider Details

I. General information

NPI: 1659219582
Provider Name (Legal Business Name): LAKESHORE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 BROOKWOOD BLVD
BIRMINGHAM AL
35209-6801
US

IV. Provider business mailing address

511 BROOKWOOD BLVD
BIRMINGHAM AL
35209-6801
US

V. Phone/Fax

Practice location:
  • Phone: 205-941-7391
  • Fax: 205-244-4000
Mailing address:
  • Phone: 205-941-7391
  • Fax: 205-244-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN PAK
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 205-941-7391