Provider Demographics
NPI:1255691796
Name:SOUTH LAKE FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:SOUTH LAKE FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-520-5580
Mailing Address - Street 1:1223 S LAKE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6889
Mailing Address - Country:US
Mailing Address - Phone:803-520-5580
Mailing Address - Fax:803-520-5586
Practice Address - Street 1:1223 S LAKE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-6889
Practice Address - Country:US
Practice Address - Phone:803-520-5580
Practice Address - Fax:803-520-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental