Provider Demographics
NPI:1013256635
Name:LAKESIDE ORAL SURGERY PLLC
Entity Type:Organization
Organization Name:LAKESIDE ORAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:COWDEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-751-3312
Mailing Address - Street 1:3100 W BRITTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2058
Mailing Address - Country:US
Mailing Address - Phone:405-751-3312
Mailing Address - Fax:405-751-3524
Practice Address - Street 1:3100 W BRITTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2058
Practice Address - Country:US
Practice Address - Phone:405-751-3312
Practice Address - Fax:405-751-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty