Provider Demographics
NPI:1598873317
Name:LAKE ARBOR DENTAL ASSOC
Entity Type:Organization
Organization Name:LAKE ARBOR DENTAL ASSOC
Other - Org Name:PC OF DC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-547-0900
Mailing Address - Street 1:411 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003
Mailing Address - Country:US
Mailing Address - Phone:202-547-0900
Mailing Address - Fax:202-547-4085
Practice Address - Street 1:411 8TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-547-0900
Practice Address - Fax:202-547-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC03980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========Medicare UPIN