Provider Demographics
NPI:1003378183
Name:LAKESIDE DENTAL DESIGNS, PLLC
Entity Type:Organization
Organization Name:LAKESIDE DENTAL DESIGNS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-319-9915
Mailing Address - Street 1:49 WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-3720
Mailing Address - Country:US
Mailing Address - Phone:978-866-6481
Mailing Address - Fax:
Practice Address - Street 1:637 LOWELL ST STE A-90
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2318
Practice Address - Country:US
Practice Address - Phone:978-319-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty