Provider Demographics
NPI:1689071623
Name:LAKEVIEW DENTAL
Entity Type:Organization
Organization Name:LAKEVIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-869-0001
Mailing Address - Street 1:2291 S FORT APACHE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5895
Mailing Address - Country:US
Mailing Address - Phone:702-869-0001
Mailing Address - Fax:702-869-5554
Practice Address - Street 1:2291 S FORT APACHE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5895
Practice Address - Country:US
Practice Address - Phone:702-869-0001
Practice Address - Fax:702-869-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty