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General NPI Number Information
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NPI Number | 1801196134
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Entity Type | Organization
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Legal Business Name | LAKE DENTAL OF SARATOGA, PC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 176 LAKE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2529
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Country | US
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Telephone | 518-935-0068
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Fax | 518-581-1145
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Provider Business Mailing Address
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Address Line | 176 LAKE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2529
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Country | US
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Telephone | 518-935-0068
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Fax | 518-581-1145
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Authorized Official
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Title or Position | BOOK KEEPER
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Name | MRS. TRACIE LYNN DENNIS
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Credential |
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Telephone | 518-817-2490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 022051-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 052845
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License Number State | NY
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