Provider Demographics
NPI:1467807412
Name:LAKELAND SMILES, PLLC
Entity Type:Organization
Organization Name:LAKELAND SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILLARGEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-863-7511
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:PELICAN RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56572-0302
Mailing Address - Country:US
Mailing Address - Phone:218-863-7511
Mailing Address - Fax:
Practice Address - Street 1:22 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572-4126
Practice Address - Country:US
Practice Address - Phone:218-863-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12224261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental