Provider Demographics
NPI:1770671968
Name:LAKE CITY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LAKE CITY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-374-8010
Mailing Address - Street 1:804 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-4400
Mailing Address - Country:US
Mailing Address - Phone:843-374-2021
Mailing Address - Fax:843-374-2030
Practice Address - Street 1:804 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-4400
Practice Address - Country:US
Practice Address - Phone:843-374-2021
Practice Address - Fax:843-374-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty