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General NPI Number Information
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NPI Number | 1376966598
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Entity Type | Organization
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Legal Business Name | LADY LAKE DENTAL CARE, LLC
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 13915 N US HIGHWAY 441
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City | LADY LAKE
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State | FL
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Zip | 32159-8924
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Country | US
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Telephone | 352-753-6365
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Fax | 352-753-9865
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Provider Business Mailing Address
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Address Line | 13915 N US HIGHWAY 441
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City | LADY LAKE
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State | FL
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Zip | 32159-8924
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Country | US
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Telephone | 352-753-6365
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Fax | 352-753-9865
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Authorized Official
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Title or Position | MGR
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Name | MS. SONIA E J
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Credential |
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Telephone | 321-945-9545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN13227
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License Number State | FL
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