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General NPI Number Information
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NPI Number | 1972727253
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Entity Type | Organization
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Legal Business Name | LAKESIDE ENDODONTICS
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22 STATE ROUTE 10 W SUITE 102
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1731
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Country | US
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Telephone | 973-598-1600
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Fax | 973-598-1618
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Provider Business Mailing Address
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Address Line | 22 ROUTE 10 WEST SUITE 102
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City | SUCCASUNNA
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State | NJ
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Zip | 07876
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Country | US
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Telephone | 973-598-1600
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Fax | 973-598-1618
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | KAREN FERRARO
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Credential |
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Telephone | 973-598-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22D101956300
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License Number State | NJ
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