Provider Demographics
NPI:1710188933
Name:LAKEVIEW DENTAL COORPERATION
Entity Type:Organization
Organization Name:LAKEVIEW DENTAL COORPERATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-985-2273
Mailing Address - Street 1:3626 W 5600 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9161
Mailing Address - Country:US
Mailing Address - Phone:801-985-2273
Mailing Address - Fax:801-459-8781
Practice Address - Street 1:3626 W 5600 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9161
Practice Address - Country:US
Practice Address - Phone:801-985-2273
Practice Address - Fax:801-459-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5370773990001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty