Provider Demographics
NPI:1922530898
Name:LSL DENTAL PLLC
Entity Type:Organization
Organization Name:LSL DENTAL PLLC
Other - Org Name:ADVANCED PERIODONTICS AND IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-762-9292
Mailing Address - Street 1:761 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-6612
Mailing Address - Country:US
Mailing Address - Phone:781-762-9292
Mailing Address - Fax:781-769-4842
Practice Address - Street 1:761 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-6612
Practice Address - Country:US
Practice Address - Phone:781-762-9292
Practice Address - Fax:781-769-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty