Provider Demographics
NPI:1932367430
Name:LAWRENCE KOTOK LESLIE WILCOX LLC
Entity Type:Organization
Organization Name:LAWRENCE KOTOK LESLIE WILCOX LLC
Other - Org Name:DUNKIRK DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-420-9876
Mailing Address - Street 1:16342 COUNTY ROAD 30
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1207
Mailing Address - Country:US
Mailing Address - Phone:763-420-9876
Mailing Address - Fax:763-420-2354
Practice Address - Street 1:16342 COUNTY ROAD 30
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1207
Practice Address - Country:US
Practice Address - Phone:763-420-9876
Practice Address - Fax:763-420-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty