Provider Demographics
NPI:1558462861
Name:PETER A. LAKATOS, DMD, PC
Entity Type:Organization
Organization Name:PETER A. LAKATOS, DMD, PC
Other - Org Name:TOTAL PATIENT CARE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAKATOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-773-1200
Mailing Address - Street 1:70 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4568
Mailing Address - Country:US
Mailing Address - Phone:802-773-1200
Mailing Address - Fax:802-773-9467
Practice Address - Street 1:70 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4568
Practice Address - Country:US
Practice Address - Phone:802-773-1200
Practice Address - Fax:802-773-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00005981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005436Medicaid