Provider Demographics
NPI:1689254757
Name:LAKETOWN FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:LAKETOWN FAMILY DENTAL, PLLC
Other - Org Name:SMILE SUITES DENTAL, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LENDBURGH
Authorized Official - Last Name:HEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-670-2851
Mailing Address - Street 1:340 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3733
Mailing Address - Country:US
Mailing Address - Phone:231-737-2273
Mailing Address - Fax:
Practice Address - Street 1:340 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3733
Practice Address - Country:US
Practice Address - Phone:231-737-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental