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General NPI Number Information
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NPI Number | 1386006906
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Entity Type | Organization
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Legal Business Name | LAKEVIEW DENTAL, LLC
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 1402 ROYAL PALM BEACH BLVD STE 500
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1694
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Country | US
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Telephone | 561-898-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 ROYAL PALM BEACH BLVD. STE 500
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411
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Country | US
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Telephone | 561-898-1010
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SHAYAN GHODSI
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Credential |
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Telephone | 561-898-1010
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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 |
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License Number State |
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