Healthcare Provider Details

I. General information

NPI: 1851205355
Provider Name (Legal Business Name): LAKE CITY DENTAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 GRAVELLY POINT DR
PLATTSBURGH NY
12901-6925
US

IV. Provider business mailing address

42 GRAVELLY POINT DR
PLATTSBURGH NY
12901-6925
US

V. Phone/Fax

Practice location:
  • Phone: 438-886-1194
  • Fax:
Mailing address:
  • Phone: 438-886-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ADAM BELMADANI
Title or Position: PRESIDENT
Credential: DMD
Phone: 438-886-1194