Provider Demographics
NPI:1578154688
Name:LAKEVIEW FAMILY DENTAL - KEEGO HARBOR
Entity Type:Organization
Organization Name:LAKEVIEW FAMILY DENTAL - KEEGO HARBOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:NAKISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-230-3362
Mailing Address - Street 1:7010 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2017
Mailing Address - Country:US
Mailing Address - Phone:248-363-3304
Mailing Address - Fax:
Practice Address - Street 1:2819 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1448
Practice Address - Country:US
Practice Address - Phone:248-683-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty