Provider Demographics
NPI:1922134535
Name:LAKES FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:LAKES FAMILY DENTISTRY P.C.
Other - Org Name:LAKES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-363-8285
Mailing Address - Street 1:2900 UNION LAKE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3500
Mailing Address - Country:US
Mailing Address - Phone:248-363-8285
Mailing Address - Fax:248-363-8287
Practice Address - Street 1:2900 UNION LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3500
Practice Address - Country:US
Practice Address - Phone:248-363-8285
Practice Address - Fax:248-363-8287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty