Provider Demographics
NPI:1609889302
Name:LAKES DENTAL CARE PLC
Entity Type:Organization
Organization Name:LAKES DENTAL CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EMERALD
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-829-4511
Mailing Address - Street 1:14213 GOLF COURSE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-829-4511
Mailing Address - Fax:218-829-5483
Practice Address - Street 1:14213 GOLF COURSE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-829-4511
Practice Address - Fax:218-829-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty