Provider Demographics
NPI:1679670814
Name:LAKEMAN, DAN M (DMD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:M
Last Name:LAKEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HWY 13
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565
Mailing Address - Country:US
Mailing Address - Phone:205-486-2731
Mailing Address - Fax:205-485-8584
Practice Address - Street 1:1001 HWY 13
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565
Practice Address - Country:US
Practice Address - Phone:205-486-2731
Practice Address - Fax:205-485-8584
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1031Medicare UPIN