Provider Demographics
NPI:1023349487
Name:LAKEVIEW DENTAL CENTER, LLC
Entity type:Organization
Organization Name:LAKEVIEW DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ZERR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-370-8778
Mailing Address - Street 1:2601 25TH ST SE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1279
Mailing Address - Country:US
Mailing Address - Phone:503-370-8778
Mailing Address - Fax:
Practice Address - Street 1:2601 25TH ST SE
Practice Address - Street 2:SUITE 430
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1279
Practice Address - Country:US
Practice Address - Phone:503-370-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD56481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty