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General NPI Number Information
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NPI Number | 1740016898
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Entity Type | Organization
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Legal Business Name | LAKE CITY DENTAL P.L.L.C.
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 210 N LAKESHORE DR
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City | LAKE CITY
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State | MN
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Zip | 55041-1551
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Country | US
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Telephone | 651-345-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 6037 S POINTE DR SW
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City | ROCHESTER
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State | MN
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Zip | 55902-2545
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Country | US
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Telephone | 507-993-4713
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. THOMAS LEWIS
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Credential | DDS
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Telephone | 507-993-4713
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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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