Provider Demographics
NPI:1326280553
Name:LAKE CITY DENTAL CLINIC
Entity Type:Organization
Organization Name:LAKE CITY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-944-2331
Mailing Address - Street 1:700 NORTH HENSON ST
Mailing Address - Street 2:PO BOX 999
Mailing Address - City:LAKE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81235-0999
Mailing Address - Country:US
Mailing Address - Phone:970-944-2331
Mailing Address - Fax:970-944-2320
Practice Address - Street 1:700 NORTH HENSON ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:CO
Practice Address - Zip Code:81235-0999
Practice Address - Country:US
Practice Address - Phone:970-944-2331
Practice Address - Fax:970-944-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty