Provider Demographics
NPI:1447385885
Name:LAKESIDE DENTAL CARE
Entity Type:Organization
Organization Name:LAKESIDE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-833-3200
Mailing Address - Street 1:1000 CW FAGAN DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-345-4166
Mailing Address - Fax:985-345-4213
Practice Address - Street 1:3000 W ESPLANADE AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1877
Practice Address - Country:US
Practice Address - Phone:504-833-3200
Practice Address - Fax:504-833-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA52931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty