Provider Demographics
NPI:1386006906
Name:LAKEVIEW DENTAL, LLC
Entity Type:Organization
Organization Name:LAKEVIEW DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHODSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-898-1010
Mailing Address - Street 1:1402 ROYAL PALM BEACH BLVD. STE 500
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:561-898-1010
Mailing Address - Fax:
Practice Address - Street 1:1402 ROYAL PALM BEACH BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1694
Practice Address - Country:US
Practice Address - Phone:561-898-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty